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Nationwide rates for HCPCS C5274

Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $3,630.78 / $5,011.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50,118.72 / $50,118.72 / $53,703.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $758.58 / $2,454.71