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North Dakota rates for HCPCS 15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $831.76 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $794.33 / $1,174.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,698.24 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,698.24 / $2,344.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $1,000.00 / $2,137.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,584.89 / $6,456.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,677.35 / $5,128.61 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,258.93 / $1,819.70