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South Dakota rates for HCPCS L0120

Cervical Flexible Non-Adjustable Prefabricated Off-The-Shelf (Foam Collar) (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.14 / $22.14 / $22.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.56 / $19.73 / $25.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.18 / $31.55 / $43.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.13 / $37.50 / $46.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.52 / $34.54 / $160.57
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.91 / $19.05 / $39.90
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.47 / $43.86 / $57.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.32 / $44.46 / $83.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.94 / $29.20 / $34.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.68 / $16.55 / $24.86
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.07 / $39.07 / $39.07