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South Dakota rates for HCPCS L0172

Cervical, collar, semi-rigid thermoplastic foam, two piece, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.57 / $118.57 / $118.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.45 / $85.90 / $116.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.38 / $141.93 / $159.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.40 / $198.00 / $247.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.57 / $171.65 / $749.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.20 / $94.71 / $169.76
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.29 / $159.10 / $274.49
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.30 / $161.34 / $304.04
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.94 / $145.10 / $172.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.20 / $98.83 / $196.24
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.75 / $141.75 / $141.75