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South Carolina rates for HCPCS 15121

Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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
$144.02 / $547.29 / $16,467.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,709.21 / $5,405.49 / $8,981.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$580.00 / $580.00 / $580.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.61 / $231.32 / $338.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.00 / $1,221.00 / $3,585.00