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South Dakota rates for HCPCS 15156

Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; additional 1 sq cm to 75 sq cm (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.33 / $144.25 / $144.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.09 / $134.33 / $144.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.32 / $337.35 / $421.69
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.64 / $232.77 / $419.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.33 / $358.14 / $1,389.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.00 / $349.34 / $467.20
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.23 / $349.34 / $440.25
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.36 / $263.95 / $310.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.10 / $274.73 / $437.44
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.80 / $326.39 / $348.20