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Kansas 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
$1,886.00 / $4,747.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800.00 / $3,281.00 / $7,655.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.10 / $768.56 / $1,279.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$624.00 / $624.00 / $624.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.00 / $550.00 / $1,685.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.00 / $550.00 / $1,769.00