go back

South Dakota rates for HCPCS V2103

Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 0.12 to 2.00d cylinder, per lens

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.02 / $39.34 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.38 / $54.38 / $67.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.02 / $50.52 / $83.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.13 / $20.36 / $261.22
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.90 / $45.00 / $79.59
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.78 / $40.65 / $43.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.09 / $50.52 / $63.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.94 / $20.36 / $43.54
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.74 / $36.74 / $36.74