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Illinois rates for HCPCS 54112

Exc Penile Plaque Graft > 5 Cm Length

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,017.00 / $1,892.00 / $5,405.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,523.21 / $13,671.56 / $24,674.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$620.00 / $620.00 / $643.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.68 / $1,581.89 / $4,026.49
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,300.00 / $5,978.00 / $12,241.00