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Wisconsin rates for HCPCS Q4012

Cast Supplies Short Arm Cast Pediatric (0-10 Years) Fiberglass

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $7.08 / $7.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $8.77 / $29.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.19 / $12.19 / $20.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.34 / $12.19 / $13.89
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.19 / $26.09 / $26.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.44 / $37.90 / $50.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.97 / $17.80 / $23.06
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.99 / $10.03 / $12.80
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.19 / $12.19 / $14.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.08 / $10.03 / $17.77
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.62 / $6.92 / $47.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.07 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.99 / $10.03 / $12.80
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.19 / $12.19 / $14.70
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.19 / $18.29 / $31.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.80 / $24.75 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.97 / $53.55 / $178.44
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.19 / $12.19 / $12.19
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.19 / $12.19 / $24.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.30 / $6.08 / $10.13