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Wisconsin rates for HCPCS Q4042

Cast supplies, long leg splint, adult (11 years +), fiberglass

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.75 / $24.75 / $24.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.93 / $24.75 / $35.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.64 / $42.64 / $70.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.65 / $42.64 / $48.60
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.64 / $91.25 / $91.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.44 / $133.72 / $177.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.39 / $61.88 / $80.70
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.46 / $35.13 / $42.64
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.74 / $34.74 / $42.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.75 / $35.13 / $44.77
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.67 / $24.10 / $117.34
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.77 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.46 / $35.13 / $42.64
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.74 / $34.74 / $42.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.64 / $63.96 / $112.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.28 / $86.56 / $199.56
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.39 / $187.38 / $418.74
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.64 / $42.64 / $42.64
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.64 / $42.64 / $58.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.92 / $21.27 / $39.47