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South Dakota rates for HCPCS V2304

Spherocylinder Trifocal Plano To Plus Or Minus 4.00d Sphere 2.25-4.00d Cylinder Per Lens

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.36 / $70.06 / $86.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $97.13 / $121.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.48 / $88.56 / $146.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.28 / $40.31 / $500.06
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.00 / $88.86 / $157.52
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.77 / $75.47 / $80.45
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.86 / $88.56 / $111.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.50 / $35.28 / $83.65
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.70 / $72.70 / $72.70