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South Dakota rates for HCPCS Q4014

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.16 / $21.16 / $21.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.93 / $20.07 / $62.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.50 / $49.50 / $61.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.63 / $38.63 / $48.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.54 / $38.33 / $62.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.22 / $26.43 / $335.71
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.39 / $37.81 / $47.75
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.34 / $37.00 / $72.64
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.68 / $33.18 / $43.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.02 / $16.55 / $27.58
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.86 / $29.86 / $29.86