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Nebraska 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
$3,034.03 / $6,048.00 / $13,841.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,056.00 / $1,556.10 / $11,100.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,335.87 / $4,387.57 / $8,486.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$762.00 / $1,242.00 / $4,406.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$492.44 / $586.37 / $771.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,031.00 / $1,775.00 / $4,406.00