go back

South Dakota rates for HCPCS V2625

Enlargement of ocular prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.17 / $490.48 / $572.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.88 / $670.88 / $838.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$479.20 / $583.91 / $966.71
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.62 / $292.22 / $2,931.93
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$462.00 / $651.54 / $1,155.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$499.31 / $533.62 / $589.92
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.61 / $585.75 / $736.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.53 / $233.36 / $487.04
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,482.00 / $1,482.00 / $1,482.00