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South Dakota rates for HCPCS L0174

Cervical Collar Semi-Rigid Thermoplastic Foam Two Piece With Thoracic Extension Prefabricated Off-The-Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$233.14 / $233.14 / $233.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.67 / $204.45 / $247.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.42 / $244.45 / $360.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$388.88 / $388.88 / $486.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$238.14 / $398.84 / $1,611.98
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.19 / $230.74 / $367.31
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$299.61 / $360.33 / $593.91
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.56 / $365.40 / $688.59
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.95 / $353.50 / $420.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.89 / $180.59 / $335.53
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.02 / $321.02 / $321.02