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South Dakota rates for HCPCS Q4028

Cast supplies, hip spica (one or both legs), pediatric (0-10 years), fiberglass

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.02 / $47.02 / $47.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.02 / $47.02 / $50.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.00 / $110.00 / $137.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.50 / $85.50 / $106.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.34 / $85.18 / $138.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.37 / $58.74 / $648.41
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.87 / $84.00 / $106.11
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.44 / $82.24 / $161.44
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.49 / $73.73 / $97.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.48 / $36.79 / $61.31
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.36 / $66.36 / $66.36