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South Dakota rates for HCPCS 0449T

Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; initial device

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$761.72 / $761.72 / $3,511.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.53 / $737.59 / $883.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$932.63 / $941.95 / $1,165.78
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$634.54 / $1,029.01 / $2,041.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$719.55 / $1,210.20 / $2,167.62
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,210.20 / $1,281.49 / $5,847.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,210.20 / $1,226.18 / $1,540.60
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
$812.12 / $1,377.50 / $2,142.78