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South Dakota rates for HCPCS 65778

Placement of amniotic membrane on the ocular surface; without sutures

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $1,479.11 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $1,071.52 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $134.90 / $3,801.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $831.76 / $2,290.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,995.26 / $4,570.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $131.83 / $3,235.94
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $1,778.28 / $2,454.71
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
$67.61 / $1,202.26 / $3,630.78
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $100.00 / $2,884.03