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South Dakota rates for HCPCS L8035

Custom breast prosthesis, post mastectomy, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $3,715.35 / $3,715.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $3,235.94 / $3,890.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,090.30 / $3,090.30 / $4,897.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,128.61 / $5,128.61 / $6,456.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $4,570.88 / $12,022.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,951.21 / $22,387.21
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $4,786.30 / $4,786.30
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $4,897.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,981.07 / $3,981.07 / $7,943.28
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,715.35 / $4,466.84 / $5,888.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,951.21 / $4,677.35
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,265.80 / $4,265.80 / $4,265.80