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South Dakota rates for HCPCS 15136

Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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)

Facilitymedian $123 · 10th–90th $83–$4,3650%10%20%10th90th$123Professionalmedian $123 · 10th–90th $79–$2140%10%20%10th90th$123$100.0$200.0$500.0$1.0K$2.0K

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
$83.18 / $89.13 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $89.13 / $141.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $218.78 / $275.42
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $134.90 / $251.19
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $177.83 / $758.58
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $208.93 / $223.87
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $181.97
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $162.18 / $194.98
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $151.36 / $251.19
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $173.78 / $208.93