go back

North Carolina rates for HCPCS 15200

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$651.88 / $1,052.96 / $8,413.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.84 / $718.41 / $1,025.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$654.29 / $910.57 / $1,679.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$679.57 / $894.47 / $1,766.97
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$651.88 / $856.11 / $1,258.88
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.00 / $606.00 / $978.52
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
$653.79 / $817.05 / $2,011.01
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,402.71 / $3,402.71 / $26,542.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,868.39 / $6,049.44 / $7,128.75