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Washington rates for HCPCS C5276

Low Cost Skin Substitute App

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,064.40 / $6,470.00 / $22,024.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$474.00 / $1,200.00 / $3,781.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.10 / $21.10 / $27.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.92 / $1,110.00 / $1,110.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.00 / $588.00 / $5,793.00