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South Dakota rates for HCPCS Q4022

Cast Supplies Short Arm Splint Adult (11 Years +) Fiberglass

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.69 / $9.69 / $9.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.39 / $18.69 / $56.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.50 / $22.50 / $28.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.63 / $17.63 / $22.03
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.20 / $17.98 / $33.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.05 / $12.10 / $293.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.67 / $17.30 / $21.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.88 / $16.94 / $46.55
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.67 / $15.20 / $20.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.37 / $12.62 / $17.48
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.68 / $13.68 / $13.68