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North Dakota rates for HCPCS 15221

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.73 / $135.77 / $8,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.33 / $111.08 / $135.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.44 / $175.30 / $294.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.51 / $203.59 / $332.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.73 / $135.77 / $230.81
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.31 / $249.07 / $1,510.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.83 / $202.25 / $354.43