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South Dakota rates for HCPCS G0117

Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.36 / $70.12 / $73.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $72.72 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.61 / $70.09 / $398.92
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.13 / $87.38 / $113.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.06 / $76.86 / $122.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.67 / $70.09 / $137.08
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.30 / $126.10 / $148.40