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South Dakota rates for HCPCS 67515

Injection of medication or other substance into Tenon's capsule

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.79 / $55.02 / $55.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.79 / $83.14 / $110.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.53 / $117.64 / $147.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.53 / $68.50 / $252.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.79 / $171.39 / $383.56
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.76 / $127.61 / $167.53
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.16 / $145.01 / $181.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.95 / $86.24 / $158.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.20 / $115.11 / $241.30
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.80 / $107.20 / $117.20