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South Carolina rates for HCPCS 15260

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $6,025.60 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $933.25 / $2,137.96
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $954.99 / $1,778.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $3,630.78 / $6,606.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $954.99 / $1,380.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $501.19 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,023.29 / $1,412.54
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,288.25
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $1,000.00 / $1,445.44
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
$691.83 / $891.25 / $1,584.89