go back

South Dakota rates for HCPCS V2624

Polishing/Resurfacing Of Ocular Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.12 / $61.20 / $90.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.75 / $84.75 / $105.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.12 / $92.92 / $153.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.46 / $37.02 / $482.28
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.00 / $80.38 / $142.49
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.83 / $72.78 / $79.22
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.52 / $92.92 / $116.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.54 / $37.02 / $77.26
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.00 / $77.00 / $77.00