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South Dakota rates for HCPCS 67120

Removal of implanted material, posterior segment; extraocular

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$589.37 / $722.14 / $722.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$503.58 / $841.83 / $1,613.01
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,197.95 / $1,441.04 / $2,051.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$673.34 / $1,061.63 / $1,280.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00