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South Dakota rates for HCPCS 66175

Trluml Dilat Aqueous O/F Can W/Retention Dev/St

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$770.34 / $770.34 / $4,338.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$544.33 / $960.16 / $2,779.92
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,526.70 / $2,075.16 / $6,380.43
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$958.87 / $1,320.16 / $1,628.62
Sanford Health Plan
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$363.16 / $363.16 / $363.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00