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Colorado rates for HCPCS C5277

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 greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,532.00 / $4,955.00 / $10,651.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.17 / $532.17 / $532.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,974.00 / $2,971.00 / $7,022.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.01 / $8.01 / $8.01
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$532.17 / $558.79 / $894.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$730.00 / $1,464.00 / $3,011.00