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Louisiana 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
$580.00 / $1,544.00 / $3,779.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.17 / $2,698.00 / $3,779.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$593.39 / $1,107.46 / $1,905.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.00 / $513.00 / $1,226.00