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South Dakota rates for HCPCS 15101

Split-thickness autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Facilitymedian $182 · 10th–90th $102–$4,3650%10%20%10th90th$182Professionalmedian $257 · 10th–90th $182–$3550%10%10th90th$257$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $181.97 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $245.47 / $478.63
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $251.19 / $416.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $257.04 / $354.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $812.83