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South Dakota rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.05 / $334.19 / $334.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.59 / $286.33 / $334.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.96 / $605.75 / $958.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$286.33 / $473.61 / $875.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.56 / $757.02 / $2,508.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.49 / $757.02 / $1,913.58
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.49 / $624.78 / $928.37
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$334.65 / $491.95 / $659.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.30 / $670.66 / $944.58
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.40 / $483.80 / $739.90