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South Dakota rates for HCPCS 67901

Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.02 / $863.47 / $863.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$513.21 / $934.93 / $1,965.07
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,176.05 / $1,539.00 / $2,074.90
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$777.67 / $1,133.36 / $1,518.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.00 / $2,714.00 / $2,714.00