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South Dakota rates for HCPCS 15115

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children

Facilitymedian $977 · 10th–90th $661–$4,3650%10%20%10th90th$977Professionalmedian $1,047 · 10th–90th $661–$1,8200%10%10th90th$1,047$1.0K$2.0K$5.0K

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
$660.69 / $776.25 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $741.31 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,412.54 / $1,862.09 / $2,344.23
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$741.31 / $1,148.15 / $2,041.74
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $1,584.89 / $6,025.60
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,584.89 / $1,819.70
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,412.54 / $1,412.54 / $1,659.59
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $1,380.38 / $1,584.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $1,288.25 / $2,137.96
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $1,445.44 / $1,778.28