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North Dakota rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.18 / $340.31 / $8,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.66 / $278.94 / $340.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$438.57 / $567.58 / $789.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.30 / $620.41 / $1,038.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$225.18 / $340.31 / $675.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.82 / $581.53 / $1,622.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$353.32 / $588.86 / $884.40