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South Dakota rates for HCPCS V2521

Contact Lens Hydrophilic Toric Or Prism Ballast Per Lens (Special Coverage Instructions Apply. See Cim: 45-7 65-1)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.02 / $216.49 / $243.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.75 / $336.75 / $420.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$236.70 / $242.38 / $400.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.57 / $120.92 / $1,394.74
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.00 / $284.32 / $504.02
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.61 / $232.85 / $257.41
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.19 / $242.38 / $304.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.13 / $108.72 / $212.44
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.62 / $232.62 / $232.62