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South Dakota rates for HCPCS 67875

Temporary closure of eyelids by suture (eg, Frost suture)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.44 / $199.27 / $199.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $153.50 / $215.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.12 / $379.49 / $522.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.91 / $216.31 / $440.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.69 / $325.49 / $801.00
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$224.16 / $400.33 / $743.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.16 / $323.64 / $490.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.72 / $212.38 / $346.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.00 / $2,000.00 / $2,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.44 / $320.94 / $499.24
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.10 / $220.60 / $412.70