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South Carolina rates for HCPCS 15155

Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$789.92 / $4,230.00 / $9,727.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$584.37 / $789.92 / $1,134.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$584.09 / $1,063.98 / $1,835.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675.36 / $732.36 / $1,042.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,200.28 / $3,200.28 / $3,200.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.60 / $834.04 / $1,130.52
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.73 / $823.11 / $1,069.39
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,872.87 / $2,872.87 / $2,872.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.88 / $525.69 / $867.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $12,798.00 / $19,665.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.25 / $770.48 / $1,271.29