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North Dakota rates for HCPCS 15200

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$668.66 / $836.12 / $8,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$641.82 / $717.46 / $836.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,340.04 / $1,665.51 / $1,959.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,167.67 / $1,646.45 / $2,193.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$668.66 / $931.46 / $2,005.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$863.62 / $1,533.86 / $6,214.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$853.94 / $1,323.26 / $1,804.60