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Wisconsin rates for HCPCS Q4014

Cast Supplies Gauntlet Cast (Includes Lower Forearm And Hand) Adult (11 Years +) Fiberglass

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.26 / $19.26 / $19.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.93 / $19.91 / $83.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.18 / $33.18 / $54.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.86 / $33.18 / $37.82
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.18 / $71.01 / $71.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.21 / $104.25 / $138.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.54 / $48.28 / $62.79
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.03 / $27.33 / $33.39
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.79 / $27.79 / $33.18
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.26 / $27.33 / $34.84
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.31 / $18.25 / $42.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.28 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.03 / $27.33 / $33.39
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.79 / $27.79 / $33.18
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.18 / $49.77 / $87.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.80 / $67.36 / $155.28
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.54 / $145.80 / $335.71
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.18 / $33.18 / $33.18
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.18 / $33.18 / $46.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.72 / $16.55 / $27.58