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South Dakota rates for HCPCS 0100T

Placement of a subconjunctival retinal prosthesis receiver and pulse generator, and implantation of intra-ocular retinal electrode array, with vitrectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.70 / $4,365.16 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,698.24 / $1,819.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $3,548.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $2,454.71 / $4,677.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,454.71 / $5,623.41
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $4,365.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $8,709.64 / $8,709.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,691.53 / $5,128.61