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South Dakota rates for HCPCS 66150

Fstlj Sclera Glaucoma Trephin W/Iridectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$936.43 / $936.43 / $936.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$767.64 / $936.43 / $1,526.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,828.06 / $2,011.64 / $2,514.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$767.64 / $1,102.71 / $2,283.73
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$806.17 / $1,579.91 / $2,756.67
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,582.22 / $2,031.66 / $3,141.50
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,275.00 / $2,031.66 / $2,321.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$943.76 / $1,429.61 / $1,683.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$873.28 / $1,579.91 / $2,457.64
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,640.40 / $2,007.10 / $2,007.10