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South Dakota rates for HCPCS 67108

Repair of retinal detachment; with vitrectomy, any method, including, when performed, air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,255.29 / $1,255.29 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,255.29 / $1,378.00 / $3,729.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,453.92 / $2,700.36 / $3,375.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,029.14 / $1,739.25 / $4,500.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,110.96 / $2,271.36 / $3,767.91
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,216.54 / $2,934.93 / $3,585.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,849.65 / $2,788.99 / $3,305.26
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,387.89 / $1,996.11 / $2,657.38
Sanford Health Plan
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$438.83 / $438.83 / $438.83
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$438.83 / $438.83 / $438.83
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
$1,434.54 / $2,390.90 / $3,342.14
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,217.90 / $2,713.70 / $2,713.70