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South Carolina rates for HCPCS 15276

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.32 / $3,776.00 / $9,727.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.26 / $29.73 / $51.89
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.80 / $24.80 / $41.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.25 / $505.67 / $1,172.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.07 / $30.16 / $45.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.11 / $36.32 / $47.92
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.03 / $35.39 / $44.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.49 / $35.58 / $48.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.00 / $1,221.00 / $3,585.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.99 / $32.94 / $60.57