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South Dakota rates for HCPCS 67015

Aspiration/Release Vitreous Subretinal/Choroidal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$647.52 / $647.52 / $2,290.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$500.82 / $541.21 / $969.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,255.99 / $1,382.12 / $1,727.65
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$529.07 / $803.56 / $1,521.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$544.04 / $1,066.33 / $1,824.06
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,130.60 / $1,350.99 / $1,839.55
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.41 / $1,350.99 / $1,604.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$627.41 / $952.11 / $1,156.66
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
$636.59 / $1,048.57 / $1,658.75
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,127.20 / $1,379.20 / $1,379.20