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South Dakota rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Facilitymedian $79 · 10th–90th $40–$4,3650%10%20%10th90th$79Professionalmedian $78 · 10th–90th $39–$1620%10%10th90th$78$50.0$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
$39.81 / $79.43 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $64.57 / $109.65
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $131.83 / $229.09
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $97.72 / $208.93
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $141.25 / $3,388.44
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $104.71 / $169.82
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $131.83
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $117.49 / $154.88
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
$52.48 / $93.33 / $181.97
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $95.50 / $173.78