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North Carolina rates for HCPCS 15201

Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.28 / $217.57 / $7,278.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.28 / $137.55 / $220.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$361.00 / $896.00 / $2,229.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$368.08 / $368.08 / $16,394.00