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South Dakota rates for HCPCS 0622T

Trabeculostomy ab interno by laser; with use of ophthalmic endoscope

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $302.00 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $302.00 / $331.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $407.38 / $870.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $467.74 / $1,000.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $426.58 / $426.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $501.19 / $891.25