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South Dakota rates for HCPCS V2520

Contact Lens Hydrophilic Spherical Per Lens (Special Coverage Instructions Apply. See Cim: 45-7 65-1)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.39 / $122.23 / $239.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.25 / $170.25 / $212.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.23 / $125.17 / $209.09
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.87 / $62.45 / $801.07
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.00 / $161.72 / $286.70
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $132.47 / $146.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.41 / $125.17 / $157.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.89 / $52.04 / $104.08
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.33 / $132.33 / $132.33