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South Dakota rates for HCPCS 67113

Rpr Complex Retina Detach Vitrect &Membrane Peel

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,403.70 / $1,403.70 / $4,338.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,403.70 / $1,493.04 / $2,816.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,740.67 / $3,015.90 / $3,769.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$992.69 / $1,759.39 / $4,604.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,240.85 / $2,534.92 / $3,815.73
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,477.09 / $3,078.32 / $4,007.62
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,063.65 / $3,113.16 / $3,596.93
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,524.30 / $2,182.61 / $2,862.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$489.79 / $489.79 / $489.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$489.79 / $489.79 / $489.79
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
$1,467.59 / $2,400.48 / $3,734.08
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,475.80 / $3,029.20 / $3,029.20