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South Carolina rates for HCPCS 15200

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $8,709.64 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $724.44 / $1,202.26
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $562.34 / $562.34
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
$602.56 / $776.25 / $1,122.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $575.44 / $575.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $831.76 / $1,122.02
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,122.02
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $831.76 / $1,230.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $10,964.78 / $16,982.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $741.31 / $1,258.93