go back

Washington 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
$2,064.40 / $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