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South Dakota rates for HCPCS 67141

Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage; cryotherapy, diathermy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $288.40 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $380.19 / $630.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $630.96 / $794.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $338.84 / $1,288.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $954.99 / $3,019.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $1,122.02 / $1,202.26
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $457.09 / $812.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $630.96 / $1,412.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $489.78 / $616.60