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South Carolina rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $4,897.79 / $16,595.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $69.18 / $158.49
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $41.69 / $41.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $741.31 / $1,348.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $64.57 / $102.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $70.79 / $104.71
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $67.61 / $102.33
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
$38.02 / $61.66 / $109.65