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North Carolina 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
$1,181.00 / $4,922.05 / $7,968.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$650.00 / $901.00 / $7,278.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.11 / $564.11 / $798.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$361.00 / $896.00 / $2,229.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00