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Idaho 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
$532.17 / $532.17 / $5,519.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.17 / $532.17 / $532.17
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$532.17 / $532.17 / $532.17
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,016.89 / $1,451.69 / $1,937.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,800.00 / $8,244.00 / $9,193.00