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North Carolina rates for HCPCS 15120

Split-thickness 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 (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $3,162.28 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $831.76 / $2,290.87
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $660.69 / $1,445.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,023.29 / $1,862.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,000.00 / $1,819.70
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,348.96
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $891.25 / $1,258.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $9,549.93 / $14,454.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $812.83 / $1,584.89
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,220.18 / $11,220.18 / $28,840.32
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,165.95 / $6,165.95 / $7,079.46