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Utah rates for HCPCS 54112

Excision of penile plaque (Peyronie disease); with graft greater than 5 cm in length

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $3,715.35 / $4,897.79
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,803.84 / $16,218.10 / $36,307.81
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,445.44 / $1,949.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,128.61 / $13,803.84