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South Dakota rates for HCPCS 29058

Application, cast; plaster Velpeau

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.07 / $92.07 / $125.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.90 / $106.31 / $271.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.50 / $263.92 / $363.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.17 / $179.66 / $291.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.56 / $277.66 / $927.52
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.36 / $212.32 / $287.08
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.50 / $212.32 / $279.52
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.23 / $185.66 / $249.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $821.00 / $821.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.12 / $222.20 / $337.46
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.20 / $225.40 / $303.10