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Rhode Island 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
$2,090.73 / $2,778.87 / $3,955.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,060.10 / $1,301.49 / $3,664.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$540.00 / $1,401.00 / $4,915.00