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Kentucky 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
$557.00 / $2,200.00 / $8,229.00
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
$3,013.00 / $3,389.00 / $3,766.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.01 / $8.01 / $8.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,111.00 / $1,111.00 / $1,111.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.00 / $597.00 / $1,895.00