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South Dakota rates for HCPCS V2113

Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.93 / $64.89 / $74.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.68 / $102.75 / $128.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.93 / $76.34 / $125.99
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.41 / $37.57 / $474.71
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$82.83 / $87.00 / $146.84
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.06 / $67.84 / $75.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.67 / $76.34 / $95.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.42 / $30.41 / $63.47
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.77 / $67.77 / $67.77