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Wisconsin rates for HCPCS Q4028

Cast Supplies Hip Spica (One Or Both Legs) Pediatric (0-10 Years) Fiberglass

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.81 / $42.81 / $42.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.96 / $42.81 / $61.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.73 / $73.73 / $121.65
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.56 / $73.73 / $84.05
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.73 / $157.78 / $157.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$198.25 / $231.67 / $307.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.08 / $106.88 / $139.54
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.30 / $60.76 / $73.73
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.98 / $53.98 / $73.73
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.30 / $60.76 / $77.42
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.00 / $41.69 / $182.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.81 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.30 / $60.76 / $73.73
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.98 / $53.98 / $73.73
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.73 / $110.60 / $194.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.00 / $149.66 / $345.06
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.08 / $324.00 / $648.41
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.73 / $73.73 / $73.73
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.73 / $73.73 / $73.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.06 / $36.79 / $61.31