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South Dakota rates for HCPCS Q4042

Cast Supplies Long Leg Splint Adult (11 Years +) Fiberglass

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.19 / $27.19 / $27.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.19 / $27.19 / $29.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.50 / $63.50 / $79.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.50 / $49.50 / $61.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.83 / $49.26 / $79.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $33.97 / $418.74
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.76 / $48.58 / $61.37
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.00 / $47.56 / $93.36
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.56 / $42.64 / $56.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.16 / $21.27 / $35.45
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.38 / $38.38 / $38.38