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South Dakota rates for HCPCS 67028

Intravitreal Njx Pharmacologic Agt Spx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.53 / $341.85 / $1,053.20
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$1,121.52 / $1,817.21 / $1,817.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.18 / $117.00 / $199.84
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$159.97 / $166.73 / $845.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.49 / $260.22 / $325.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.07 / $142.10 / $354.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.90 / $231.26 / $1,169.94
Medica
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$603.61 / $603.61 / $1,033.71
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.46 / $236.02 / $303.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.54 / $236.02 / $308.70
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.52 / $168.40 / $218.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.60 / $202.66 / $285.29
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.20 / $211.40 / $260.00