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South Dakota rates for HCPCS 15116

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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
$127.15 / $143.22 / $143.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.65 / $228.11 / $439.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$278.00 / $341.96 / $456.77
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$179.68 / $254.05 / $298.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00