go back

South Dakota rates for HCPCS 54390

Plastic operation on penis for epispadias distal to external sphincter; with exstrophy of bladder

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,112.13 / $1,112.13 / $1,112.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,031.64 / $1,112.13 / $3,565.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,705.22 / $2,768.14 / $3,460.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,475.25 / $1,879.50 / $3,448.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,478.53 / $2,464.21 / $12,343.06
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,932.08 / $3,062.71 / $3,782.36
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,283.27 / $2,705.22 / $3,281.11
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,543.93 / $2,082.92 / $2,404.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,598.10 / $3,309.45 / $3,457.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,343.40 / $2,756.90 / $2,867.20