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Wisconsin rates for HCPCS Q4106

Dermagraft, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.96 / $35.96 / $35.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.96 / $36.40 / $38.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.54 / $36.31 / $125.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.14 / $110.03 / $155.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $57.23 / $135.80
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.14 / $37.29 / $53.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.14 / $37.29 / $55.02
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.94 / $50.94 / $106.97
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.42 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.14 / $37.29 / $53.58
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.60 / $68.11 / $94.87
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.04 / $85.00 / $152.21
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $123.30 / $1,816.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.94 / $50.94 / $69.75