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South Dakota rates for HCPCS 67042

Vitrectomy, mechanical, pars plana approach; with removal of internal limiting membrane of retina (eg, for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil)

Facilitymedian $4,365 · 10th–90th $1,202–$9,1200%20%10th90th$4,365Professionalmedian $2,042 · 10th–90th $1,175–$6,1660%10%10th90th$2,042$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $4,365.16 / $9,120.11
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,202.26 / $2,041.74 / $6,165.95
Avera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,290.87 / $2,290.87 / $2,290.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,344.23 / $2,630.27 / $3,311.31
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$851.14 / $1,412.54 / $3,235.94
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,548.82 / $3,311.31
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,691.53 / $2,691.53 / $2,754.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,412.54 / $1,905.46 / $2,187.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
80
Typical Low / Median / Typical High
$436.52 / $436.52 / $436.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Typical Low / Median / Typical High
$436.52 / $436.52 / $436.52
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,466.84 / $4,466.84 / $8,511.38
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $2,238.72 / $3,235.94
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,630.27 / $2,630.27