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Utah rates for HCPCS Q4026

Cast supplies, hip spica (one or both legs), adult (11 years +), fiberglass

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.66 / $61.66 / $61.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $104.71 / $380.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $60.26 / $131.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $104.71 / $104.71
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $147.91 / $151.36
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $151.36 / $181.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $63.10 / $102.33