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South Dakota rates for HCPCS 67221

Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy (includes intravenous infusion)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $288.40 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $288.40 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $602.56 / $831.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $338.84 / $741.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $501.19 / $2,041.74
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $501.19 / $660.69
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $407.38 / $537.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $1,659.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $407.38 / $758.58
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $478.63 / $645.65