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South Dakota rates for HCPCS 15131

Dermal 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
$83.18 / $91.20 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $89.13 / $158.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $223.87 / $275.42
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $141.25 / $245.47
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $173.78 / $758.58
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $208.93 / $223.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $173.78 / $190.55
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $162.18 / $194.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $158.49 / $251.19
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.49 / $173.78 / $213.80