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South Dakota rates for HCPCS 65150

Reinsertion Ocular Implt W/Wo Conjunctival Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$766.38 / $766.38 / $3,073.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$619.58 / $766.38 / $1,233.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,433.24 / $1,608.06 / $2,010.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$619.58 / $941.04 / $1,601.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$576.86 / $1,096.03 / $1,818.19
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,266.04 / $1,366.03 / $2,380.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$882.95 / $1,366.03 / $1,886.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$705.00 / $962.22 / $1,335.85
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
$634.54 / $1,153.72 / $1,793.32
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,301.90 / $1,592.90 / $1,592.90