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South Dakota rates for HCPCS 15760

Graft; composite (eg, full thickness of external ear or nasal ala), including primary closure, donor area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.02 / $829.51 / $829.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.47 / $721.58 / $1,226.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.03 / $1,943.08 / $2,428.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$842.94 / $1,198.10 / $2,165.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$779.89 / $2,101.88 / $6,301.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,342.00 / $1,829.19 / $2,364.42
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,229.00 / $1,742.40 / $2,259.48
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$918.03 / $1,366.25 / $1,652.18
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
$924.83 / $1,696.34 / $2,356.34
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,252.20 / $1,532.00 / $1,852.70