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Mississippi 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
$618.00 / $1,250.00 / $1,831.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.36 / $494.36 / $543.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$527.00 / $527.00 / $527.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$339.62 / $339.62 / $747.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.00 / $529.00 / $1,739.00