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South Dakota rates for HCPCS L8049

Repair or modification of maxillofacial prosthesis, labor component, 15 minute increments, provided by a nonphysician

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.36 / $28.36 / $28.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.36 / $28.36 / $55.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.60 / $12.60 / $12.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.71 / $12.60 / $36.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.54 / $92.95 / $150.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.04 / $17.66 / $24.73
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.90 / $36.90 / $36.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.51 / $36.90 / $38.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.83 / $17.66 / $22.08
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.00 / $32.00 / $32.00