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South Dakota rates for HCPCS 54120

Amputation of penis; partial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $3,090.30 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $891.25 / $1,778.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,380.38 / $1,479.11
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,071.52 / $1,230.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28