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North Carolina rates for HCPCS 15221

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 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
$67.40 / $202.93 / $7,278.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.55 / $117.19 / $194.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.20 / $143.74 / $280.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.48 / $136.62 / $249.79
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.40 / $128.10 / $202.14
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.56 / $163.56 / $600.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$361.00 / $896.00 / $2,229.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.37 / $136.22 / $329.20
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$333.88 / $333.88 / $16,394.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,392.00 / $1,510.76 / $1,510.76