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South Dakota rates for HCPCS 15775

Punch graft for hair transplant; 1 to 15 punch grafts

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $363.08 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $316.23 / $562.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $724.44 / $1,096.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $457.09 / $812.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $616.60 / $2,754.23
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $512.86 / $741.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $602.56
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $501.19 / $724.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.03 / $501.19 / $831.76
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $562.34 / $812.83