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South Dakota rates for HCPCS 76513

Dx Ophthalmic Us Ant Segment Immersion Uni/Bi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$33.15 / $33.15 / $33.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.78 / $87.51 / $124.27
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$28.59 / $33.15 / $50.93
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$39.19 / $55.88 / $80.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.33 / $174.53 / $218.17
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.96 / $74.47 / $93.08
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$66.12 / $100.07 / $125.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.41 / $186.78 / $583.91
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.81 / $67.68 / $335.18
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$64.59 / $119.10 / $353.01
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$111.61 / $111.61 / $111.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.00 / $184.37 / $221.35
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.22 / $126.53 / $157.97
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$39.04 / $54.47 / $62.10
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$56.94 / $72.52 / $98.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.88 / $150.22 / $192.22
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$37.94 / $44.17 / $72.06
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$51.94 / $78.17 / $120.16
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.19 / $155.50 / $155.50
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.90 / $67.00 / $67.00
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$75.30 / $88.60 / $88.60