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North Dakota rates for HCPCS 15121

Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, 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
$125.89 / $204.17 / $8,511.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $208.93 / $398.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,677.35 / $5,128.61 / $5,128.61