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South Dakota rates for HCPCS Q4004

Cast supplies, shoulder cast, adult (11 years +), fiberglass

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.93 / $96.93 / $96.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.93 / $103.90 / $138.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.50 / $226.50 / $283.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.25 / $176.25 / $220.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.35 / $175.59 / $284.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.55 / $121.10 / $835.71
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.71 / $173.17 / $218.76
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.90 / $167.19 / $222.59
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.78 / $151.99 / $201.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.71 / $126.38 / $174.79
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.79 / $136.79 / $136.79