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Wisconsin rates for HCPCS Q4101

Apligraf, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $41 · 10th–90th $30–$1700%20%40%10th90th$41Professionalmedian $31 · 10th–90th $30–$1260%50%10th90th$31$5.0$20.0$100.0$500.0$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $30.90 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $37.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $45.71 / $74.13
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$40.74 / $77.62 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $83.18 / $125.89
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $30.90 / $67.61
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $33.88 / $79.43
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $30.90 / $77.62
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $63.10
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $58.88 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $81.28
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$31.62 / $32.36 / $54.95
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $229.09 / $416.87
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $85.11 / $134.90
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $36.31 / $2,187.76
Security Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $257.04 / $380.19
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $40.74 / $257.04
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $70.79
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $125.89 / $134.90