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South Dakota rates for HCPCS 67027

Implantation of intravitreal drug delivery system (eg, ganciclovir implant), includes concomitant removal of vitreous

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$897.33 / $897.33 / $897.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.83 / $1,217.74 / $2,243.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,581.42 / $1,965.26 / $2,823.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$916.51 / $1,380.26 / $1,621.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00