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South Dakota rates for HCPCS 66172

Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,584.89 / $3,981.07
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $2,754.23 / $2,754.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,995.26 / $2,511.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$446.68 / $446.68 / $446.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53