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South Dakota rates for HCPCS 15157

Tissue cultured skin 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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.79 / $161.15 / $161.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.72 / $146.79 / $161.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.81 / $377.08 / $471.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.91 / $259.27 / $438.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.64 / $398.43 / $1,516.65
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$325.00 / $388.64 / $508.91
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.58 / $388.64 / $480.46
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.78 / $269.45 / $345.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.07 / $307.17 / $477.82
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.50 / $355.40 / $387.40