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South Dakota rates for HCPCS 67041

Vitrectomy, mechanical, pars plana approach; with removal of preretinal cellular membrane (eg, macular pucker)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $3,981.07 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,348.96 / $3,715.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,344.23 / $2,630.27 / $3,311.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $1,412.54 / $3,235.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,659.59 / $9,549.93
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,454.71 / $2,691.53 / $2,691.53
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,905.46 / $2,187.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$436.52 / $436.52 / $436.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $4,466.84 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $2,041.74 / $3,235.94
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,511.89 / $2,630.27