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North Carolina rates for HCPCS 15115

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$674.28 / $1,098.02 / $7,278.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.77 / $708.30 / $1,123.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$746.24 / $858.18 / $1,738.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.93 / $982.86 / $1,873.95
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$674.28 / $844.94 / $1,194.35
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.00 / $600.00 / $1,044.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.00 / $3,733.00 / $6,097.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$659.43 / $802.75 / $1,831.28
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,806.47 / $4,806.47 / $16,394.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,082.96 / $5,877.44 / $6,859.58