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South Dakota rates for HCPCS 15131

Dermal Autograft Trunk/Arm/Leg Ea 100 Cm/Ea

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.70 / $91.91 / $91.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.73 / $83.70 / $91.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.71 / $216.59 / $270.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.49 / $145.47 / $238.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.93 / $225.53 / $758.33
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.00 / $215.83 / $275.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.54 / $214.70 / $269.56
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.85 / $152.01 / $190.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.10 / $174.71 / $271.77
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.50 / $195.10 / $214.00