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South Carolina rates for HCPCS 15261

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $6,025.60 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $173.78 / $380.19
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
$114.82 / $208.93 / $354.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $501.19 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $204.17 / $288.40
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $316.23 / $316.23
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $199.53 / $302.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $1,202.26 / $3,548.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $177.83 / $309.03