go back

New Jersey 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
$3,059.00 / $5,975.00 / $10,692.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.17 / $532.17 / $6,396.00
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,433.32 / $2,641.30 / $3,227.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,529.00 / $3,352.00 / $10,536.00