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North Dakota rates for HCPCS 15155

Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$730.92 / $798.77 / $8,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$683.71 / $730.92 / $981.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,453.13 / $1,598.52 / $1,880.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,160.61 / $1,721.44 / $2,427.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$730.92 / $937.55 / $2,192.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$782.97 / $1,281.22 / $5,361.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.84 / $1,231.58 / $2,073.03