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South Dakota rates for HCPCS 0621T

Trabeculostomy ab interno by laser

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.58 / $220.58 / $220.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.92 / $220.58 / $229.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.92 / $328.10 / $628.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.15 / $374.08 / $668.67
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.98 / $371.07 / $3,981.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.10 / $339.92 / $1,034.58
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
$237.75 / $338.52 / $656.49