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South Carolina rates for HCPCS 15101

Split-thickness autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $7,943.28 / $16,595.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,897.79 / $9,332.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $575.44 / $575.44
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $338.84 / $338.84
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $173.78 / $275.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $1,202.26 / $3,548.13