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South Dakota rates for HCPCS 67560

Orbital implant (implant outside muscle cone); removal or revision

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,196.61 / $1,196.61 / $3,073.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$972.08 / $1,396.39 / $2,663.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,963.16 / $2,333.11 / $2,777.32
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,078.83 / $1,620.50 / $2,114.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00