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South Carolina rates for HCPCS C5273

Application Of Low Cost Skin Substitute Graft To Trunk Arms Legs 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
$5,159.99 / $7,182.00 / $16,467.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,182.00 / $7,182.00 / $9,062.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,309.61 / $2,963.79 / $4,720.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,604.11 / $1,604.11 / $1,604.11
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,575.67 / $1,575.67 / $1,575.67
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
$30.00 / $30.00 / $30.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$659.00 / $6,607.00 / $8,667.00