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South Dakota rates for HCPCS 15135

Dermal 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $851.14 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $776.25 / $1,318.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,041.74 / $2,570.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $1,230.27 / $2,238.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,659.59 / $6,456.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,698.24 / $1,949.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $1,778.28
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,445.44 / $1,698.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,445.44 / $2,290.87
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,548.82 / $1,905.46