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Oregon rates for HCPCS C5275

Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$649.01 / $5,649.00 / $15,341.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.58 / $35.18 / $35.18
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.58 / $27.58 / $59.30
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$447.15 / $1,520.00 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.58 / $28.96 / $59.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,250,000.00 / $2,250,000.00 / $2,400,000.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,400.90 / $1,985.16 / $2,351.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$376.00 / $3,290.00 / $6,216.00