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South Dakota rates for HCPCS 65875

Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); posterior synechiae

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $676.08 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $794.33 / $1,737.80
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,445.44 / $1,445.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,047.13 / $1,230.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53