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South Dakota rates for HCPCS 65785

Implantation Intrastromal Corneal Ring Segments

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$472.53 / $2,396.51 / $2,396.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.98 / $1,896.10 / $3,746.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.07 / $2,761.55 / $6,024.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$410.70 / $1,331.27 / $5,195.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,810.45 / $4,046.89 / $7,841.21
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,025.07 / $3,943.66 / $5,796.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,025.07 / $3,164.20 / $5,805.59
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.08 / $2,359.61 / $3,932.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,190.82 / $4,259.88 / $6,713.32
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$981.30 / $1,020.50 / $4,689.10