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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)

Facilitymedian $126 · 10th–90th $65–$4,3650%10%20%10th90th$126Professionalmedian $132 · 10th–90th $65–$2750%10%10th90th$132$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $125.89 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $109.65 / $181.97
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $190.55 / $371.54
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $154.88 / $331.13
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $269.15 / $1,513.56
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $162.18 / $309.03
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $281.84
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $181.97 / $245.47
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $158.49 / $338.84
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $147.91 / $275.42