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North Dakota rates for HCPCS 15115

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$682.54 / $796.22 / $8,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.69 / $688.74 / $933.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,391.98 / $1,610.94 / $1,895.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,189.38 / $1,701.30 / $2,266.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$682.54 / $986.63 / $2,047.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$818.94 / $1,432.62 / $5,163.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,025.00 / $5,025.00 / $5,025.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$804.95 / $1,254.80 / $1,718.48