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South Dakota rates for HCPCS L8010

Breast prosthesis, mastectomy sleeve

Insurance Carrier
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.75 / $58.33 / $72.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.18 / $146.91 / $146.91
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.98 / $52.92 / $194.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.64 / $45.18 / $63.73
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.81 / $45.79 / $69.43
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.23 / $96.23 / $96.23