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South Dakota rates for HCPCS 15276

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, 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)

Facilitymedian $31 · 10th–90th $1–$2,2910%10%20%10th90th$31Professionalmedian $32 · 10th–90th $22–$690%20%10th90th$32$1.0$5.0$20.0$100.0$500.0$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
$0.83 / $30.90 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.38 / $28.84 / $41.69
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $69.18 / $95.50
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$29.51 / $42.66 / $89.13
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $69.18 / $2,570.40
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $58.88 / $79.43
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $70.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $53.70 / $63.10
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
$28.84 / $50.12 / $85.11
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $53.70 / $70.79