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Oregon 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
$532.17 / $5,649.00 / $15,341.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.17 / $532.17 / $6,616.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$431.76 / $1,520.00 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,400,000.00 / $2,400,000.00 / $2,400,000.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,250,000.00 / $2,250,000.00 / $2,400,000.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,400.90 / $1,985.16 / $2,487.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$376.00 / $3,290.00 / $6,216.00