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South Dakota rates for HCPCS 66155

Fistulization of sclera for glaucoma; thermocauterization with iridectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$935.69 / $935.69 / $935.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$767.34 / $935.69 / $1,525.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,826.64 / $2,010.08 / $2,512.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$767.34 / $1,102.28 / $2,294.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$805.52 / $1,578.60 / $2,754.43
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,572.28 / $2,029.99 / $3,141.50
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,271.00 / $2,029.99 / $2,320.32
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$942.99 / $1,429.74 / $1,681.94
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
$760.77 / $1,521.57 / $2,455.60
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,639.20 / $2,005.60 / $2,005.60