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North Dakota rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, 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
$44.66 / $78.59 / $8,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.27 / $62.71 / $80.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.13 / $153.12 / $193.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.29 / $127.64 / $204.46
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.66 / $78.59 / $133.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.56 / $126.81 / $2,932.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.20 / $89.72 / $169.62