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South Dakota rates for HCPCS 67250

Scleral reinforcement (separate procedure); without graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $3,548.13 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,071.52 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,089.30 / $2,630.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $1,148.15 / $2,187.76
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,202.26 / $6,760.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $1,862.09 / $1,862.09
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,318.26 / $1,737.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,445.44 / $2,238.72
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $1,949.84 / $2,041.74