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South Dakota rates for HCPCS V2109

Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.14 / $50.58 / $66.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.89 / $91.88 / $114.84
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.14 / $59.35 / $98.21
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.71 / $29.69 / $368.02
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.00 / $65.45 / $116.04
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.72 / $53.60 / $59.26
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.63 / $59.51 / $74.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.24 / $23.71 / $49.48
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.56 / $53.56 / $53.56