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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