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South Dakota rates for HCPCS 15110

Epidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $794.33 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $1,148.15 / $2,089.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $1,819.70
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,380.38 / $1,621.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26