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South Dakota rates for HCPCS 54112

Exc Penile Plaque Graft > 5 Cm Length

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$841.33 / $841.33 / $3,073.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,117.22 / $1,421.85 / $2,605.73
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.00 / $2,449.39 / $10,138.50
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,173.72 / $1,561.32 / $1,820.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00