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South Dakota rates for HCPCS V2204

Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.98 / $55.77 / $66.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.00 / $77.25 / $96.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.98 / $68.40 / $112.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.25 / $32.67 / $407.81
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.00 / $72.03 / $127.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.31 / $59.00 / $65.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.11 / $68.40 / $86.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.35 / $27.25 / $56.88
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.93 / $58.93 / $58.93