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South Dakota rates for HCPCS 67221

Dstrj Lesion Choroid Photodynamic Therapy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.87 / $291.22 / $291.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.74 / $253.90 / $365.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$427.63 / $588.22 / $809.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.53 / $340.81 / $746.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.18 / $543.38 / $1,548.96
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.77 / $609.89 / $713.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$449.06 / $573.00 / $722.99
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.79 / $404.17 / $542.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,643.00 / $1,643.00 / $1,643.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.58 / $492.20 / $787.11
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.60 / $475.90 / $646.40