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South Dakota rates for HCPCS V2121

Lenticular Lens, Per Lens, Sngle

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.52 / $79.81 / $91.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.60 / $120.38 / $150.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.52 / $93.90 / $154.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.40 / $45.34 / $710.69
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.00 / $99.96 / $177.20
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.05 / $81.86 / $90.50
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.33 / $93.90 / $118.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.50 / $37.40 / $78.08
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.78 / $81.78 / $81.78