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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
$44.35 / $106.70 / $5,449.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.56 / $62.71 / $128.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.55 / $83.45 / $155.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.75 / $85.65 / $153.69
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.35 / $85.50 / $102.87
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.23 / $92.23 / $92.23
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
$60.92 / $76.31 / $174.31
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $209.24 / $209.24
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,050.27 / $3,050.27 / $3,512.93