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South Dakota rates for HCPCS 54205

Njx Peyronie W/Surg Expos Plaque

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$482.08 / $482.08 / $482.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.30 / $482.08 / $1,528.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,170.29 / $1,205.27 / $1,506.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.07 / $814.72 / $1,483.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$635.70 / $1,059.50 / $3,983.12
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$927.00 / $1,394.78 / $4,555.17
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$930.00 / $1,170.29 / $1,413.57
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.00 / $884.81 / $1,040.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $10,167.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.73 / $1,064.54 / $1,486.35
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,013.80 / $1,192.70 / $1,240.40