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South Dakota rates for HCPCS 15120

Split-thickness 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 (except 15050)

Facilitymedian $2,692 · 10th–90th $661–$12,0230%10%10th90th$2,692Professionalmedian $891 · 10th–90th $661–$1,7780%10%20%10th90th$891$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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 / $3,090.30 / $12,022.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $776.25 / $1,122.02
Avera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,380.38 / $1,380.38
Avera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,445.44 / $1,445.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,412.54 / $1,949.84 / $2,454.71
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $1,148.15 / $2,137.96
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $1,659.59 / $6,309.57
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,513.56 / $1,584.89 / $1,949.84
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,445.44 / $1,778.28
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,380.38 / $1,659.59
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,162.28 / $3,162.28
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $1,318.26 / $2,137.96
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,513.56 / $1,862.09