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Texas rates for HCPCS C5272

Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$521.00 / $2,244.00 / $7,513.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.00 / $36.00 / $36.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,845.00 / $5,646.00 / $8,585.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.00 / $36.00 / $51.48
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.00 / $36.00 / $51.48
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,250,000.00 / $2,250,000.00 / $2,400,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.00 / $952.00 / $2,405.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.00 / $16.00 / $21.60