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South Dakota rates for HCPCS 15135

Dermal Autograft F/S/N/H/F/G/M/D Gt 1st 100

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$729.02 / $855.17 / $855.17
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$637.41 / $739.64 / $855.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,562.56 / $1,986.71 / $2,483.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$915.64 / $1,274.82 / $2,199.16
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.50 / $1,960.64 / $6,484.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,424.00 / $2,011.55 / $3,929.20
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,564.07 / $1,909.73 / $2,345.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$927.86 / $1,390.74 / $1,697.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$991.67 / $1,714.94 / $2,425.75
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,357.10 / $1,660.40 / $1,903.40