go back

Oregon rates for HCPCS C5276

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; 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
$2,747.00 / $6,629.40 / $8,728.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,704.00 / $4,704.00 / $20,400.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,400,000.00 / $2,400,000.00 / $2,400,000.00
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
$376.00 / $4,113.00 / $6,216.00