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South Dakota rates for HCPCS V2315

Lenticular, (myodisc), per lens, trifocal

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.86 / $119.95 / $139.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.47 / $166.13 / $207.66
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.85 / $143.21 / $236.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.06 / $71.45 / $897.48
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.00 / $157.53 / $279.26
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.08 / $129.02 / $142.63
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.46 / $143.21 / $180.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.94 / $59.54 / $119.08
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.88 / $128.88 / $128.88