go back

South Carolina rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.25 / $5,866.00 / $9,062.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$219.64 / $290.08 / $554.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$584.09 / $1,136.88 / $1,939.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.03 / $259.35 / $424.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,604.11 / $1,604.11 / $1,604.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.08 / $319.73 / $460.58
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.13 / $334.38 / $447.23
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,397.41 / $1,397.41 / $1,397.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.29 / $329.52 / $450.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$659.00 / $6,607.00 / $8,667.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.41 / $326.73 / $679.10