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South Dakota rates for HCPCS 15278

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; 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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.35 / $92.72 / $92.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.71 / $79.56 / $92.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.73 / $157.47 / $263.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.29 / $130.53 / $241.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.55 / $199.99 / $5,990.92
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.06 / $174.14 / $230.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.78 / $160.78 / $252.42
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.83 / $136.01 / $182.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.91 / $164.83 / $256.39
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.00 / $121.10 / $204.60