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South Dakota rates for HCPCS 15769

Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia)

Facilitymedian $3,802 · 10th–90th $457–$6,7610%10%20%10th90th$3,802Professionalmedian $692 · 10th–90th $437–$2,2910%10%20%10th90th$692$500.0$1.0K$2.0K$5.0K$10.0K

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
$457.09 / $3,801.89 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $478.63 / $2,290.87
Avera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,168.69 / $4,168.69 / $4,168.69
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $1,096.48 / $1,380.38
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $676.08 / $1,202.26
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $891.25 / $3,548.13
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,096.48 / $1,096.48
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $1,000.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $831.76 / $933.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,162.28 / $3,162.28
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $851.14 / $1,318.26
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $870.96 / $1,047.13