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Montana rates for HCPCS Q4004

Cast supplies, shoulder cast, adult (11 years +), fiberglass

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.04 / $108.87 / $438.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.59 / $159.59 / $159.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.01 / $159.59 / $159.59
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.35 / $159.59 / $195.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.78 / $119.78 / $178.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.33 / $64.45 / $75.83