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Washington rates for HCPCS Q4004

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.71 / $86.71 / $86.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.71 / $98.19 / $144.66
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$207.80 / $289.74 / $711.31
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.17 / $133.09 / $1,113.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.01 / $62.01 / $62.01
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.61 / $203.67 / $302.70
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.56 / $203.67 / $321.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $133.58 / $151.99
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.43 / $151.99 / $167.19
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.09 / $266.18 / $394.82
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.17 / $148.43 / $170.69
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.73 / $129.19 / $151.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.45 / $96.68 / $122.97
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.19 / $129.19 / $151.99