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South Dakota rates for HCPCS 66989

Xcapsl Ctrc Rmvl Insj Io Lens Prsth Cplx Insj 1+

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$904.55 / $904.55 / $4,338.00
Aetna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$678.41 / $678.41 / $678.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$742.46 / $904.55 / $1,489.55
Aetna
Facility/Professional
Professional
Modifier
55
Low / Median / High Price
$111.37 / $135.68 / $223.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,771.42 / $1,949.31 / $2,436.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.27 / $1,061.72 / $2,034.34
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$801.59 / $1,569.62 / $2,482.62
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,393.96 / $2,026.91 / $5,644.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,664.48 / $2,026.91 / $2,581.01
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$983.98 / $1,438.36 / $1,639.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$984.80 / $1,736.10 / $2,441.63
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,598.20 / $1,955.40 / $1,955.40