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North Carolina rates for HCPCS C5274

Application of low cost 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
$903.00 / $4,311.00 / $7,968.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.00 / $725.00 / $5,449.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.28 / $199.28 / $282.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$361.00 / $896.00 / $2,229.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00