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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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.35 / $31.21 / $31.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.26 / $23.38 / $32.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.43 / $68.17 / $92.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.32 / $45.88 / $90.01
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.65 / $78.94 / $2,582.05
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.97 / $71.33 / $86.17
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.87 / $68.69 / $87.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.81 / $50.60 / $63.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.40 / $64.58 / $93.91
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.90 / $53.70 / $71.09