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North Carolina rates for HCPCS C5278

Application Of Low Cost 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 Surfacearea 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
$500.00 / $725.00 / $5,449.00
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