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South Dakota rates for HCPCS Q4013

Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), plaster

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.55 / $12.55 / $12.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.46 / $12.55 / $15.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.50 / $29.50 / $36.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.88 / $22.88 / $28.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.66 / $22.73 / $36.85
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.84 / $15.68 / $157.25
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.58 / $22.42 / $28.32
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.00 / $21.95 / $41.35
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.41 / $19.68 / $26.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.54 / $9.82 / $16.36
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.71 / $17.71 / $17.71