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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
$70.79 / $138.04 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $169.82 / $354.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $177.83 / $331.13
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $199.53 / $269.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83