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North Carolina rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $120.23 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $70.79 / $457.09
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $41.69 / $57.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $91.20 / $154.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $81.28 / $151.36
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.65 / $67.61 / $102.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $812.83 / $1,949.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $67.61 / $120.23
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $275.42 / $275.42
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $3,548.13