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South Dakota rates for HCPCS 67105

Rpr Retinal Dtchmnt Drg Subretinal Fluid Pc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.75 / $317.37 / $317.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.75 / $553.22 / $758.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$495.03 / $680.93 / $851.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.95 / $405.52 / $1,695.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.55 / $615.55 / $3,252.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.95 / $687.32 / $876.55
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.89 / $690.67 / $990.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.74 / $499.31 / $982.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,643.00 / $1,643.00 / $1,643.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.64 / $592.08 / $835.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$554.79 / $629.40 / $678.80