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South Dakota rates for HCPCS L8031

Breast prosthesis, silicone or equal, with integral adhesive

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $354.81 / $354.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $309.03 / $380.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $275.42 / $478.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $616.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $457.09 / $1,148.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $281.84 / $2,187.76
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $467.74 / $467.74
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$478.63 / $478.63 / $478.63
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $389.05 / $758.58
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $426.58 / $562.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $281.84 / $446.68
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87