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South Carolina rates for HCPCS 15131

Dermal 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
$104.71 / $4,897.79 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $89.13 / $181.97
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $3,715.35 / $6,606.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $102.33 / $165.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $109.65 / $147.91
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $102.33 / $141.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $1,202.26 / $3,548.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $91.20 / $162.18