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South Carolina rates for HCPCS C5277

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 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
$4,673.00 / $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
$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
$532.17 / $532.17 / $532.17
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