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South Dakota rates for HCPCS L8042

Orbital prosthesis, provided by a nonphysician

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $3,388.44 / $3,388.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,754.23 / $3,467.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $3,235.94 / $4,168.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,677.35 / $4,677.35 / $5,888.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,890.45 / $10,232.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,511.89 / $21,379.62
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $4,073.80 / $4,073.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,168.69 / $4,168.69 / $4,168.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $3,388.44 / $6,918.31
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $3,801.89 / $5,011.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,454.71 / $4,073.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.78 / $3,630.78 / $3,630.78