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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
$36.58 / $40.56 / $56.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $56.25 / $70.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.58 / $57.61 / $95.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.55 / $22.95 / $289.33
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.00 / $49.73 / $88.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.72 / $45.03 / $49.08
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.04 / $57.61 / $72.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.66 / $22.95 / $47.89
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.69 / $40.69 / $40.69