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South Dakota rates for HCPCS Q4016

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.57 / $10.57 / $10.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.96 / $10.57 / $30.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.50 / $24.50 / $30.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.13 / $19.13 / $23.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.27 / $19.14 / $31.04
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.61 / $13.21 / $167.85
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.18 / $18.89 / $23.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.17 / $18.48 / $36.31
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.83 / $16.57 / $21.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $8.27 / $13.79
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.92 / $14.92 / $14.92