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North Dakota rates for HCPCS 15120

Split-thickness 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 (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $851.14 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $794.33 / $1,071.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,621.81 / $1,995.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,621.81 / $2,290.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $1,023.29 / $2,570.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,548.82 / $6,309.57
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
$758.58 / $1,174.90 / $1,737.80