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North Dakota rates for HCPCS 15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$610.22 / $772.62 / $8,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.16 / $624.53 / $782.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,213.13 / $1,520.27 / $1,796.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,070.11 / $1,551.98 / $2,401.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$610.22 / $868.25 / $1,830.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$793.25 / $1,417.37 / $5,728.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,313.00 / $2,313.00 / $2,313.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$783.68 / $951.90 / $1,667.55