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South Dakota rates for HCPCS 67041

Vitrectomy Pars Plana Remove Preretinal Membrane

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,207.14 / $1,207.14 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,133.72 / $1,207.14 / $2,138.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,356.92 / $2,593.62 / $3,242.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$853.82 / $1,421.00 / $3,235.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,067.28 / $2,063.75 / $3,278.99
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,129.79 / $2,646.73 / $3,444.47
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,773.41 / $2,677.65 / $3,010.88
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,311.20 / $1,865.87 / $2,185.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$421.45 / $421.45 / $421.45
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
$1,112.53 / $2,059.57 / $3,210.28
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,129.60 / $2,605.69 / $2,605.69