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South Dakota rates for HCPCS V2522

Contact lens, hydrophilic, bifocal, per lens

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $177.83 / $234.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $407.38 / $407.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $309.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $213.80 / $416.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $125.89 / $1,621.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $239.88 / $281.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $85.11 / $186.21
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $257.04 / $257.04