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South Dakota rates for HCPCS 67505

Retrobulbar injection; alcohol

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $91.20 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $93.33 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $199.53 / $251.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $102.33 / $229.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $147.91 / $851.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $165.96 / $194.98
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $138.04 / $162.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $141.25 / $229.09
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $165.96 / $194.98