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South Dakota rates for HCPCS 67121

Rmvl Implt Matrl Posterior Segment Intraocular

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$956.80 / $956.80 / $3,073.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$784.94 / $1,166.02 / $2,391.14
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,686.17 / $1,946.86 / $2,341.67
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$976.68 / $1,471.10 / $1,730.46
Sanford Health Plan
Facility/Professional
Professional
Modifier
80
Low / Median / High Price
$332.14 / $332.14 / $332.14
Sanford Health Plan
Facility/Professional
Professional
Modifier
AS
Low / Median / High Price
$332.14 / $332.14 / $332.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00