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Indiana 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
$927.00 / $4,846.00 / $7,212.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.17 / $532.17 / $853.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,111.00 / $4,320.00 / $9,270.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$439.96 / $439.96 / $439.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.00 / $2,252.00 / $4,426.00