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South Dakota rates for HCPCS 65780

Ocular Surface Reconstruction Amniotic Membrane

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$714.66 / $714.66 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$636.98 / $767.22 / $1,063.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,238.29 / $1,362.65 / $1,703.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$517.58 / $874.71 / $2,330.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.94 / $1,200.47 / $2,097.77
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,106.28 / $1,543.10 / $2,380.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,020.78 / $1,543.10 / $1,826.21
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$717.09 / $1,024.41 / $1,458.62
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
$762.05 / $1,276.83 / $1,867.40
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,110.80 / $1,359.20 / $1,359.20