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South Carolina rates for HCPCS 15120

Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $7,244.36 / $15,848.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $758.58 / $1,737.80
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $588.84 / $1,148.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $4,897.79 / $9,332.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $851.14 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $501.19 / $3,235.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $912.01 / $1,174.90
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,348.96
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $891.25 / $1,258.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $13,182.57 / $23,442.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $794.33 / $1,412.54