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North Carolina rates for HCPCS 15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$696.61 / $1,324.72 / $7,194.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.99 / $785.28 / $1,476.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$734.96 / $1,003.05 / $1,855.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.20 / $1,003.28 / $1,823.15
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$696.61 / $916.88 / $1,359.17
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.00 / $600.00 / $1,040.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,392.88 / $3,456.00 / $6,543.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$675.56 / $846.99 / $1,927.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,597.37 / $3,597.37 / $16,394.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,155.28 / $6,224.16 / $7,385.55