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North Carolina rates for HCPCS 15130

Dermal autograft, trunk, arms, legs; 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
$579.09 / $901.00 / $7,278.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.31 / $579.09 / $705.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.25 / $702.34 / $1,353.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$614.11 / $808.67 / $1,513.18
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.09 / $741.35 / $983.15
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.00 / $600.00 / $809.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,526.00 / $7,659.00 / $10,502.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.89 / $688.50 / $1,730.76
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,046.94 / $3,046.94 / $16,394.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,326.32 / $5,170.88 / $6,114.98