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South Dakota rates for HCPCS C5271

Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.50 / $29.50 / $3,073.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.50 / $29.50 / $323.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.20 / $13.20 / $13.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.50 / $148.97 / $821.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$492.44 / $574.51 / $791.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00