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South Dakota rates for HCPCS 15155

Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less

Facilitymedian $1,023 · 10th–90th $692–$4,3650%10%20%10th90th$1,023Professionalmedian $1,047 · 10th–90th $661–$1,7780%10%10th90th$1,047$1.0K$2.0K$5.0K

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
$691.83 / $758.58 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $724.44 / $1,148.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,819.70 / $2,290.87
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $1,122.02 / $2,041.74
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $1,479.11 / $5,888.44
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,659.59 / $1,819.70
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,445.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $1,318.26 / $1,584.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,162.28 / $3,162.28
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $1,258.93 / $2,041.74
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,318.26 / $1,412.54 / $1,737.80