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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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.01 / $181.63 / $181.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.91 / $256.14 / $477.25
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$265.86 / $345.19 / $496.32
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.02 / $266.23 / $357.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00