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South Dakota rates for HCPCS L8041

Midfacial prosthesis, provided by a nonphysician

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $3,019.95 / $3,019.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,454.71 / $3,090.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $3,715.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,168.69 / $4,168.69 / $5,248.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $3,467.37 / $9,120.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,238.72 / $19,054.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $3,630.78 / $3,630.78
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $3,715.35
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $3,019.95 / $6,025.60
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $3,388.44 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,137.96 / $3,630.78
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,235.94 / $3,235.94 / $3,235.94