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South Dakota rates for HCPCS 0450T

Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; each additional device (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$321.13 / $321.13 / $2,290.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.61 / $314.22 / $321.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$466.51 / $466.51 / $590.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$305.61 / $449.33 / $821.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.66 / $550.05 / $862.75
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$377.72 / $605.09 / $775.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$540.39 / $605.09 / $775.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.12 / $632.55 / $855.65