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South Dakota rates for HCPCS 65778

Place Amniotic Membra Ocular Surface W/O Sutures

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.10 / $1,479.22 / $1,479.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.81 / $977.11 / $2,089.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.71 / $2,675.52 / $3,752.34
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.25 / $827.37 / $2,677.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,220.91 / $2,583.41 / $4,115.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.44 / $2,486.48 / $3,668.59
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.72 / $2,124.13 / $3,668.59
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.81 / $1,695.16 / $2,434.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,469.44 / $2,173.00 / $4,018.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.40 / $100.30 / $2,903.40