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South Dakota rates for HCPCS 15261

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

Facilitymedian $209 · 10th–90th $129–$4,3650%10%20%10th90th$209Professionalmedian $224 · 10th–90th $129–$4470%10%10th90th$224$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
$128.82 / $199.53 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $190.55 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $426.58 / $588.84
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $263.03 / $524.81
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $426.58 / $2,290.87
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $316.23 / $478.63
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $436.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $309.03 / $398.11
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
$165.96 / $288.40 / $524.81
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $295.12 / $446.68