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South Carolina rates for HCPCS C5275

Application of low cost 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; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.58 / $7,182.00 / $16,467.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.58 / $27.58 / $35.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.19 / $905.66 / $1,442.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$536.76 / $536.76 / $536.76
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.58 / $27.58 / $37.22
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$427.30 / $427.30 / $427.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.00 / $1,221.00 / $3,585.00