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Wisconsin rates for HCPCS Q4017

Cast Supplies Long Arm Splint Adult (11 Years +) Plaster

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.60 / $6.60 / $6.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.38 / $6.82 / $19.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.37 / $11.37 / $18.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.57 / $11.37 / $12.96
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.37 / $24.33 / $24.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.64 / $35.79 / $47.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.63 / $16.41 / $21.51
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.60 / $9.52 / $22.82
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.37 / $11.37 / $11.49
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.60 / $9.52 / $22.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $6.42 / $38.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.61 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.60 / $9.52 / $22.82
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.37 / $11.37 / $11.49
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.37 / $17.05 / $30.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.20 / $23.08 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.63 / $49.95 / $137.82
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.37 / $11.37 / $11.37
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.37 / $11.37 / $19.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.73 / $5.67 / $9.44