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North Carolina rates for HCPCS 15260

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$815.65 / $1,570.08 / $6,849.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$787.36 / $966.25 / $1,778.12
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$878.40 / $878.40 / $878.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$847.47 / $1,106.03 / $2,120.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$838.18 / $1,111.45 / $2,160.82
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$815.65 / $1,062.89 / $1,476.28
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.00 / $600.00 / $1,218.77
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,728.00 / $3,733.00 / $6,543.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$786.45 / $983.56 / $2,298.65
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,837.34 / $5,837.34 / $16,394.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,182.00 / $7,291.36 / $8,430.00