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South Dakota rates for HCPCS 67505

Retrobulbar Injection Alcohol

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.08 / $92.11 / $92.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.15 / $76.08 / $151.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.60 / $194.78 / $243.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.19 / $105.03 / $230.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.20 / $167.45 / $587.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.89 / $178.46 / $220.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.38 / $185.65 / $229.39
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.75 / $137.79 / $163.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.33 / $149.13 / $231.73
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.00 / $164.30 / $195.20