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Wisconsin rates for HCPCS A2007

Restrata, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.60 / $193.60 / $193.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.60 / $193.60 / $205.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.15 / $178.37 / $393.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.70 / $205.70 / $205.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.70 / $205.70 / $205.70
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.72 / $193.60 / $271.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.72 / $193.60 / $288.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.00 / $220.00 / $462.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.72 / $193.60 / $271.04
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.02 / $189.91 / $282.76
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$205.70 / $229.90 / $907.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.70 / $256.52 / $961.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.00 / $220.00 / $277.20