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South Dakota rates for HCPCS 15111

Epidermal 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
$92.87 / $104.15 / $104.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.16 / $166.44 / $299.05
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.00 / $249.64 / $313.91
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.63 / $188.62 / $221.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00