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Wisconsin rates for HCPCS Q4108

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

Facilitymedian $50 · 10th–90th $39–$2000%10%20%10th90th$50Professionalmedian $40 · 10th–90th $38–$1260%20%40%10th90th$40$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
$38.90 / $38.90 / $38.90
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $38.02 / $41.69
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $61.66 / $107.15
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $117.49 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $120.23 / $138.04
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $38.90 / $85.11
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $54.95
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$48.98 / $50.12 / $107.15
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $48.98 / $102.33
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
$46.77 / $46.77 / $46.77
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $47.86 / $81.28
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $229.09 / $416.87
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $85.11 / $199.53
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $57.54 / $199.53
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
$52.48 / $79.43 / $257.04
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $50.12 / $117.49
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $125.89 / $134.90