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South Dakota rates for HCPCS 53215

Urethrectomy Tot W/Cystost Male

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$876.59 / $876.59 / $4,338.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,128.14 / $1,481.44 / $2,483.30
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,602.00 / $2,423.35 / $4,555.17
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,161.18 / $1,545.65 / $1,799.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00