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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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $38.90 / $47.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $81.28 / $81.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $56.23 / $70.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $57.54 / $97.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $22.91 / $288.40
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $64.57 / $75.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.78 / $22.39 / $47.86
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $40.74 / $40.74