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North Carolina rates for HCPCS 15276

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.03 / $810.44 / $5,449.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.92 / $29.34 / $60.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.37 / $40.01 / $74.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.65 / $41.61 / $74.62
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.03 / $35.39 / $44.81
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.81 / $44.81 / $44.81
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
$28.30 / $34.88 / $75.05
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $119.42 / $119.42
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,298.42 / $2,298.42 / $2,685.33