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Wisconsin rates for HCPCS A6215

Foam Dressing Wound Filler Per Gram

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.04 / $4.04 / $4.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.86 / $4.04 / $4.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.98 / $1.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.03 / $31.59 / $41.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.98 / $5.95 / $12.66
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.04 / $4.04 / $6.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.86 / $4.04 / $6.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.23 / $11.23 / $11.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.04 / $4.04 / $6.15
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,900.00 / $5,900.00 / $5,900.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.98 / $2.98 / $2.98