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South Dakota rates for HCPCS 67043

Vitrectomy Pars Plana Remove Subretinal Membrane

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,272.00 / $1,272.00 / $4,338.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.62 / $1,595.27 / $3,415.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,246.29 / $2,791.50 / $3,632.18
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,383.78 / $1,982.21 / $2,306.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00