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North Carolina rates for HCPCS 15150

Tissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.84 / $972.46 / $7,278.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$564.63 / $627.84 / $696.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$664.57 / $761.72 / $1,456.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$661.10 / $849.84 / $1,594.99
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.84 / $757.11 / $1,007.22
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.00 / $600.00 / $850.02
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
$565.79 / $690.82 / $1,617.05
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,149.11 / $3,149.11 / $16,394.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,540.72 / $4,991.60 / $6,067.88