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South Dakota rates for HCPCS 15201

Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.95 / $137.94 / $137.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.20 / $191.80 / $379.95
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.41 / $261.00 / $378.35
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.38 / $200.15 / $268.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00