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South Dakota rates for HCPCS 15221

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 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
$64.33 / $127.92 / $127.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.25 / $109.56 / $127.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.35 / $187.96 / $362.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.03 / $173.46 / $352.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.09 / $336.73 / $1,510.76
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.16 / $239.00 / $352.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.91 / $218.00 / $352.30
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.28 / $183.76 / $246.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.16 / $242.95 / $377.92
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.10 / $149.40 / $276.39