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South Dakota rates for HCPCS V2104

Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens

Facilitymedian $58 · 10th–90th $36–$980%20%40%10th90th$58Professionalmedian $39 · 10th–90th $25–$560%20%10th90th$39$10.0$20.0$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $38.90 / $47.86
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $56.23 / $70.79
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$36.31 / $57.54 / $97.72
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.50 / $22.91 / $288.40
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $64.57 / $75.86
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$17.78 / $22.91 / $48.98
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $40.74 / $40.74