go back

South Dakota rates for HCPCS V2523

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.33 / $153.63 / $187.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.75 / $258.75 / $323.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.50 / $180.74 / $298.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $90.17 / $1,093.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$201.69 / $216.00 / $357.53
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.06 / $165.17 / $182.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.75 / $180.74 / $227.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.59 / $75.14 / $158.40
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.02 / $165.02 / $165.02