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South Dakota rates for HCPCS 67570

Optic nerve decompression (eg, incision or fenestration of optic nerve sheath)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,374.89 / $1,374.89 / $1,374.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,055.19 / $1,115.64 / $2,234.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,635.18 / $2,899.81 / $3,624.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.64 / $1,602.62 / $3,056.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,145.44 / $2,176.34 / $3,610.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,380.44 / $2,706.78 / $3,184.34
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,760.84 / $2,706.78 / $3,519.90
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,283.99 / $1,898.37 / $2,423.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,143.00 / $3,143.00 / $3,143.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,259.98 / $2,226.67 / $3,463.71
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,361.60 / $2,889.50 / $2,889.50