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Tennessee 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
$1,074.00 / $2,678.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,829.00 / $3,230.00 / $10,234.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$696.00 / $1,438.00 / $2,200.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.13 / $612.13 / $612.13
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.00 / $794.00 / $2,577.00