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South Dakota rates for HCPCS V2105

Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.82 / $41.85 / $48.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.50 / $66.75 / $83.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.82 / $49.09 / $81.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.61 / $24.56 / $315.07
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.00 / $54.15 / $96.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.95 / $44.34 / $49.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.06 / $49.23 / $61.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.23 / $19.61 / $40.93
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.31 / $44.31 / $44.31