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South Carolina rates for HCPCS 15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $6,025.60 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $660.69 / $1,122.02
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $281.84 / $562.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $3,715.35 / $6,606.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $724.44 / $1,047.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $501.19 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $776.25 / $1,047.13
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $776.25 / $1,122.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $6,760.83 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $676.08 / $1,202.26