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South Dakota rates for HCPCS 65110

Exenteration Orbit Remvl Orbital Contents Only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,421.30 / $1,421.30 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,156.70 / $1,421.30 / $2,315.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,743.50 / $3,019.01 / $3,773.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,156.70 / $1,661.60 / $3,204.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,170.28 / $2,292.92 / $3,837.79
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,380.56 / $2,777.32 / $3,295.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,874.71 / $2,858.63 / $3,522.51
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,329.06 / $2,001.11 / $2,526.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,339.38 / $2,293.42 / $3,566.78
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,462.50 / $3,013.00 / $3,013.00