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Wisconsin rates for HCPCS A6262

Wound Filler Dry Form Per Gram Not Otherwise Specified

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.39 / $0.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $1.38 / $2.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.80 / $2.11 / $2.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.77 / $1.20 / $3.83
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.39 / $0.54 / $1.33
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $0.54 / $0.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.39 / $0.54 / $1.33
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.53 / $7.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.39 / $0.54 / $1.33
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $0.54 / $0.54
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $1.54 / $2.04
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $1.34 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.88 / $3.83 / $7.07
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.53 / $1.53 / $1.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.41 / $0.70