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Missouri 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
$1,547.00 / $3,809.00 / $8,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$557.00 / $2,076.00 / $5,389.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $875.00 / $1,929.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.00 / $875.00 / $1,351.00