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Wisconsin rates for HCPCS Q4107

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

Facilitymedian $120 · 10th–90th $79$3020%20%40%10th90th$120Professionalmedian $85 · 10th–90th $79$2340%50%10th90th$85$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
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$79.43
Aetna
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$81.28
Typical High
$100.00
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$117.49
Typical High
$245.47
Cigna
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$199.53
Typical High
$389.05
Cigna
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$125.89
Typical High
$239.88
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$93.33
Typical High
$144.54
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$204.17
Medica
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$93.33
Typical High
$173.78
Medica
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$851.14
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Network Health
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$186.21
Typical High
$208.93
Quartz
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$288.40
Typical High
$416.87
Quartz
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$302.00
Quartz
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$104.71
Typical High
$851.14
Security Health
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$147.91
Security Health
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$257.04
Typical High
$380.19
Security Health
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$125.89
Typical High
$257.04
United
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$316.23
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$138.04