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South Dakota rates for HCPCS Q4015

Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), plaster

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.03 / $6.03 / $6.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $6.03 / $7.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.45 / $14.45 / $18.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.22 / $11.22 / $14.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.76 / $10.47 / $18.62
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.89 / $4.90 / $79.43
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $10.72 / $10.96
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $8.91 / $17.78
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.32 / $9.77 / $13.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.24 / $4.17 / $10.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $8.91 / $8.91