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South Dakota rates for HCPCS V2501

Contact lens, PMMA, toric or prism ballast, per lens

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.79 / $160.29 / $177.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.50 / $181.50 / $226.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.33 / $181.59 / $299.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.34 / $90.59 / $951.02
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.00 / $217.94 / $386.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.79 / $178.50 / $197.34
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.47 / $181.59 / $228.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.04 / $72.34 / $150.99
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$178.32 / $178.32 / $178.32