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Wisconsin rates for HCPCS Q4102

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

Facilitymedian $14 · 10th–90th $12–$1000%20%40%10th90th$14Professionalmedian $12 · 10th–90th $11–$1260%50%10th90th$12$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
$12.02 / $12.02 / $12.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.96 / $11.75 / $12.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15.14 / $30.20 / $30.20
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$16.22 / $30.90 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $36.31 / $125.89
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$11.75 / $11.75 / $26.30
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.18 / $13.18 / $15.85
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$11.75 / $12.02 / $75.86
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $11.75 / $24.55
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.59 / $14.13 / $14.13
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.30 / $12.88 / $21.88
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $229.09 / $416.87
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$11.75 / $85.11 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $14.45 / $1,584.89
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
$12.88 / $16.22 / $257.04
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $28.18
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $125.89 / $134.90