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South Dakota rates for HCPCS V2626

Reduction of ocular prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.73 / $233.85 / $267.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.50 / $277.50 / $346.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.20 / $236.31 / $426.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.40 / $119.47 / $1,580.44
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.00 / $351.21 / $622.60
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.12 / $287.64 / $318.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.74 / $239.46 / $301.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.54 / $119.47 / $263.41
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,482.00 / $1,482.00 / $1,482.00