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)

Retired code17 hospitals with prices

Description from CMS's HCPCS Level II code file.

This code is retired. Some hospitals still list it.

What Washington hospitals publish for this code

Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.

Prices for HCPCS C5274 by hospital
Hospital	Commercial insurance rates (lowest – highest)	Cash price	List price (before discounts)
EvergreenHealth Medical CenterKirkland	$688 – $1,99916 plans	$1,719	$2,149
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01	—	$1,989	$2,841
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01	—	$2,007	$2,867
Providence Holy Family HospitalSpokaneFile dated 2026-04-01	—	$2,104	$3,006
Providence St Joseph HospitalChewelahFile dated 2026-04-01	—	$305	$436
Providence St Mary Medical CenterWalla WallaFile dated 2026-04-01	—	$2,022	$2,888
Swedish IssaquahIssaquahFile dated 2026-04-01	—	$829	$1,727
Swedish Medical CenterSeattleFile dated 2026-04-01	—	$829	$1,727
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01	—	$829	$1,727
Virginia Mason Medical CenterSeattle	$2,875 – $3,5904 plans	$2,289	$4,488

Lowest and highest amounts each hospital lists for this code during a hospital stay, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

CMS publishes no national amount for this code.