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South Dakota rates for HCPCS 54200

Injection Peyronie Disease

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.66 / $108.55 / $108.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.18 / $117.48 / $171.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.81 / $255.16 / $341.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.96 / $170.47 / $278.79
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.65 / $299.27 / $873.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.52 / $223.48 / $289.55
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.39 / $223.48 / $283.74
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.25 / $173.37 / $219.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.65 / $201.01 / $312.68
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.00 / $206.70 / $273.80