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South Carolina rates for HCPCS 15136

Dermal 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
$97.05 / $3,776.00 / $9,727.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.70 / $97.05 / $140.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,054.52 / $3,883.00 / $6,494.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.79 / $98.00 / $150.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.77 / $107.43 / $146.94
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.93 / $104.18 / $136.94
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.44 / $100.11 / $133.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.00 / $1,221.00 / $3,585.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.48 / $94.91 / $166.09