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Iowa 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
$2,906.00 / $4,235.59 / $7,119.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,419.00 / $3,419.00 / $3,419.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $500.00 / $500.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$635.29 / $1,372.96 / $2,013.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$492.44 / $541.67 / $684.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,204.00 / $1,623.00 / $2,126.00