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South Dakota rates for HCPCS 15272

Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.61 / $23.47 / $23.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.94 / $23.47 / $25.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.94 / $45.77 / $69.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.77 / $35.10 / $70.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.21 / $60.60 / $3,779.26
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.86 / $54.25 / $66.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.38 / $52.16 / $66.42
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.23 / $35.85 / $47.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.21 / $51.92 / $71.95
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.60 / $36.29 / $53.00