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North Carolina rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.13 / $436.60 / $7,278.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.13 / $277.94 / $505.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.49 / $380.27 / $659.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.77 / $374.50 / $696.09
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.13 / $361.33 / $456.97
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.35 / $394.35 / $394.35
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
$278.42 / $334.32 / $837.83
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $1,507.44 / $1,507.44
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,591.84 / $1,873.13 / $2,871.68