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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
$3,021.27 / $3,021.27 / $3,021.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,594.06 / $3,021.27 / $3,318.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,861.13 / $2,861.13 / $3,656.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,181.63 / $4,181.63 / $5,227.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,579.87 / $5,105.95 / $16,835.74
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,353.72 / $2,260.30 / $3,821.06
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,039.89 / $3,656.00 / $6,986.53
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,994.26 / $3,707.45 / $6,986.53
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,834.38 / $3,318.35 / $3,944.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,257.61 / $2,141.56 / $2,825.37
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,257.17 / $3,257.17 / $3,257.17