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South Dakota rates for HCPCS V2755

U-V Lens Per Lens (Special Coverage Instructions Apply. See Mcm: 2130b)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.12 / $16.84 / $20.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.25 / $23.25 / $29.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.58 / $21.07 / $34.78
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.39 / $9.94 / $131.57
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.00 / $21.93 / $38.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.95 / $17.96 / $19.86
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.57 / $21.07 / $26.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.79 / $8.39 / $17.51
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.95 / $17.95 / $17.95