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South Dakota rates for HCPCS 54130

Amputation Penis Radw/Bi Inguinofemoral Lmphade

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,068.81 / $1,068.81 / $1,068.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$992.15 / $1,068.81 / $3,429.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,601.14 / $2,662.18 / $3,327.73
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,418.77 / $1,806.29 / $3,193.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,422.13 / $2,370.21 / $10,316.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.06 / $2,945.07 / $3,635.31
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,060.00 / $2,601.14 / $3,153.80
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,493.75 / $1,986.60 / $2,312.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,422.13 / $2,364.73 / $3,322.56
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,253.19 / $2,650.80 / $2,756.90