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South Dakota rates for HCPCS 92083

Visual field examination, unilateral or bilateral, with interpretation and report; extended examination (eg, Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30 degrees or quantitative, automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.58 / $69.78 / $182.70
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$25.55 / $26.87 / $79.37
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$23.69 / $32.36 / $43.93
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$26.56 / $37.85 / $49.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.27 / $120.43 / $165.79
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.28 / $50.71 / $68.56
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$33.00 / $70.62 / $97.22
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.01 / $92.97 / $122.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.57 / $90.00 / $396.63
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$23.93 / $34.90 / $167.21
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$31.24 / $44.83 / $257.11
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.77 / $134.00 / $154.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.75 / $122.00 / $143.65
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.28 / $92.78 / $123.71
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$30.62 / $34.15 / $51.11
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$43.51 / $55.48 / $72.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.60 / $75.90 / $95.33
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$22.36 / $31.56 / $43.20
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$30.67 / $41.28 / $52.13
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.30 / $116.50 / $121.10
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$35.70 / $48.70 / $50.60
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$49.70 / $67.80 / $70.50