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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)

Facilitymedian $191 · 10th–90th $129–$4,3650%20%10th90th$191Professionalmedian $263 · 10th–90th $182–$3160%20%10th90th$263$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
$128.82 / $138.04 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $218.78 / $380.19
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $316.23 / $338.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $251.19 / $302.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $812.83