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South Dakota rates for HCPCS 65779

Place Amniotic Membrane Ocular Surface Sutured

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.18 / $1,267.76 / $1,267.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.18 / $964.25 / $1,267.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.60 / $1,889.47 / $3,278.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.96 / $794.33 / $3,124.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,032.95 / $2,229.23 / $4,269.46
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.26 / $2,399.29 / $3,179.68
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.23 / $1,802.56 / $3,179.68
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.57 / $1,482.98 / $2,133.48
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
$1,118.30 / $2,019.64 / $3,467.69
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.40 / $240.70 / $2,544.00