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South Dakota rates for HCPCS V2115

Lenticular (Myodisc), Per Lens, Sngle Vision

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.83 / $88.74 / $103.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.51 / $123.00 / $153.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.83 / $105.84 / $174.68
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.17 / $44.29 / $585.98
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.00 / $97.66 / $173.12
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.98 / $88.42 / $90.22
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.28 / $105.84 / $133.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.68 / $42.17 / $88.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.90 / $79.90 / $79.90