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North Carolina rates for HCPCS 15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.57 / $1,152.24 / $7,278.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.29 / $705.16 / $1,271.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$626.41 / $853.74 / $1,608.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$647.36 / $841.01 / $1,639.04
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.57 / $786.03 / $1,157.52
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.00 / $600.00 / $922.71
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
$612.49 / $753.59 / $1,951.85
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,200.78 / $4,200.78 / $16,394.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,435.20 / $5,573.28 / $6,506.70