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South Dakota rates for HCPCS L8046

Partial facial prosthesis, provided by a nonphysician

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,715.77 / $2,715.77 / $2,715.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,331.71 / $2,715.77 / $2,982.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,808.29 / $1,808.29 / $3,286.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,759.00 / $3,796.59 / $4,698.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,318.96 / $4,589.64 / $15,133.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,216.82 / $2,031.71 / $3,434.66
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,732.46 / $3,286.25 / $6,279.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,691.46 / $3,332.50 / $6,279.94
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,547.73 / $2,982.77 / $3,545.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,130.44 / $1,946.90 / $2,780.80
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,927.75 / $2,927.75 / $2,927.75