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South Dakota rates for HCPCS 67025

Injection of vitreous substitute, pars plana or limbal approach (fluid-gas exchange), with or without aspiration (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$670.67 / $797.09 / $797.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.60 / $670.67 / $1,191.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,232.49 / $1,695.32 / $2,119.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.86 / $932.06 / $1,780.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.66 / $1,448.68 / $4,696.32
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,361.70 / $1,635.31 / $2,125.04
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,218.10 / $1,635.31 / $1,972.02
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.16 / $1,173.45 / $1,414.77
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
$796.77 / $1,448.68 / $2,073.65
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,378.80 / $1,443.20 / $1,687.00