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South Dakota rates for HCPCS 15240

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$769.77 / $910.96 / $910.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.30 / $856.37 / $1,284.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,641.36 / $2,141.75 / $2,677.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$964.71 / $1,319.67 / $2,372.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$836.00 / $2,297.03 / $6,925.92
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,415.00 / $1,964.53 / $2,444.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,295.00 / $1,914.92 / $2,479.87
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$941.39 / $1,515.08 / $1,815.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,102.57 / $1,864.76 / $2,595.29
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,428.20 / $1,747.50 / $2,036.20