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South Dakota rates for HCPCS 65135

Insertion of ocular implant secondary; after enucleation, muscles not attached to implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$939.08 / $939.08 / $3,073.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$761.84 / $939.08 / $1,516.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,766.55 / $1,982.03 / $2,477.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$761.84 / $1,094.38 / $2,062.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.01 / $1,406.65 / $2,333.46
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,482.64 / $1,768.20 / $2,673.82
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,135.02 / $1,747.11 / $2,316.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.45 / $1,229.38 / $1,648.95
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
$814.37 / $1,480.68 / $2,250.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,607.00 / $1,966.20 / $1,966.20