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South Dakota rates for HCPCS 67500

Retrobulbar Injection Medication Spx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.76 / $81.30 / $81.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.37 / $67.34 / $121.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.01 / $176.08 / $220.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.92 / $93.58 / $206.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.69 / $146.83 / $481.84
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.73 / $160.18 / $192.66
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.31 / $161.25 / $198.54
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.92 / $121.96 / $148.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.19 / $137.00 / $203.42
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.10 / $148.90 / $177.40