go back

Wisconsin rates for HCPCS Q4100

Skin Substitute, Nos

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.65 / $38.59 / $147.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.61 / $13.87 / $17.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.97 / $125.40 / $125.40
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.65 / $249.50 / $2,673.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.65 / $100.00 / $2,673.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.65 / $249.50 / $2,673.50
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
$125.40 / $125.40 / $125.40