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South Dakota rates for HCPCS Q4026

Cast supplies, hip spica (one or both legs), adult (11 years +), fiberglass

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $93.33 / $93.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $93.33 / $123.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $218.78 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $169.82 / $213.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $158.49 / $275.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $74.13 / $1,288.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $162.18 / $162.18
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $134.90 / $263.03
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $147.91 / $194.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $63.10 / $151.36
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $131.83 / $131.83