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South Dakota rates for HCPCS 15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$680.41 / $840.74 / $2,891.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.99 / $785.28 / $1,136.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,457.77 / $1,961.77 / $2,452.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$820.00 / $1,233.73 / $2,214.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$837.18 / $2,091.10 / $6,396.72
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,471.64 / $1,879.45 / $2,364.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,360.56 / $1,775.94 / $2,339.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$883.44 / $1,397.97 / $1,692.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$920.08 / $1,672.88 / $2,390.05
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,285.40 / $1,572.70 / $1,897.60