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South Dakota rates for HCPCS 54162

Lysis or excision of penile post-circumcision adhesions

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $975.04 / $3,852.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.78 / $280.74 / $412.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.99 / $577.84 / $734.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$241.81 / $370.94 / $672.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.89 / $690.93 / $1,922.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$466.42 / $612.15 / $1,679.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$390.01 / $523.27 / $686.10
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.97 / $392.02 / $499.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $4,097.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.89 / $537.08 / $721.87
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$382.00 / $467.40 / $595.50