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South Dakota rates for HCPCS L0150

Cervical Semi-Rigid Adjustable Molded Chin Cup (Plastic Collar With Mandibular/Occipital Piece)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.61 / $89.61 / $89.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.38 / $83.22 / $101.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.09 / $100.50 / $177.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.63 / $151.12 / $187.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.22 / $140.63 / $645.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.50 / $77.59 / $174.02
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.69 / $177.62 / $233.63
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.75 / $180.11 / $339.41
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.55 / $118.89 / $141.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.56 / $70.86 / $128.96
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.24 / $158.24 / $158.24