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South Dakota rates for HCPCS 65782

Ocular surface reconstruction; limbal conjunctival autograft (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,213.90 / $1,213.90 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$995.41 / $1,114.70 / $1,992.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,376.76 / $2,615.44 / $3,269.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$995.41 / $1,458.67 / $3,027.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,056.27 / $2,065.32 / $3,613.91
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.77 / $2,473.79 / $2,969.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,768.85 / $2,668.60 / $3,021.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,236.65 / $1,873.10 / $2,198.81
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
$1,261.25 / $2,041.79 / $3,212.72
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,142.90 / $2,621.90 / $2,621.90