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South Dakota rates for HCPCS C5275

Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, 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
$27.58 / $27.58 / $3,073.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.58 / $27.58 / $649.01
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.58 / $140.02 / $1,298.02
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