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South Dakota rates for HCPCS L0170

Cervical Collar Molded To Patient Model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$673.10 / $673.10 / $673.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.12 / $496.67 / $673.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$454.00 / $454.00 / $814.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$926.15 / $1,123.13 / $1,403.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$505.99 / $839.37 / $3,888.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.45 / $463.12 / $862.32
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$677.20 / $814.44 / $1,394.28
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$667.04 / $825.92 / $1,556.41
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.04 / $709.53 / $843.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.81 / $422.88 / $968.74
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$725.59 / $725.59 / $725.59