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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
$165.96 / $204.17 / $269.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $346.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $234.42 / $467.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $144.54 / $1,584.89
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $269.15 / $316.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $95.50 / $199.53
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $1,479.11