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South Dakota rates for HCPCS 67229

Extensive Retinopathy 1/> Sess Preterm Infant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,223.82 / $1,223.82 / $3,073.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$956.70 / $1,003.29 / $2,014.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,389.50 / $2,629.46 / $3,286.83
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$865.21 / $1,441.23 / $3,074.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,070.24 / $2,090.39 / $3,320.06
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$515.41 / $2,158.69 / $2,958.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,794.39 / $2,709.03 / $3,050.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,254.06 / $1,898.37 / $2,213.69
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
$1,185.80 / $2,019.48 / $3,251.72
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,157.40 / $2,639.60 / $2,639.60