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North Carolina rates for HCPCS 15278

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; 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
$55.37 / $120.13 / $5,449.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.46 / $82.63 / $266.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.10 / $100.75 / $184.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.04 / $100.75 / $182.83
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.37 / $99.22 / $119.54
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.50 / $108.50 / $108.50
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
$74.20 / $90.31 / $199.83
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $266.76 / $266.76
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.88 / $472.88 / $6,230.56