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South Dakota rates for HCPCS 15152

Tissue cultured skin 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
$129.79 / $139.36 / $139.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.27 / $223.14 / $383.59
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$276.00 / $329.65 / $427.58
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.83 / $247.75 / $298.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00