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Wisconsin rates for HCPCS Q4111

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

Facilitymedian $8 · 10th–90th $7$1000%20%10th90th$8Professionalmedian $8 · 10th–90th $7$1260%20%40%10th90th$8$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
$7.94 / $7.94 / $7.94
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.08 / $7.08 / $7.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.94 / $11.22 / $24.55
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.77 / $18.20 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.41 / $20.42 / $125.89
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.94 / $8.13 / $16.98
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.13 / $8.13 / $15.14
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.08 / $7.41 / $75.86
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.08 / $7.08 / $14.79
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $50.12 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.76 / $7.94 / $7.94
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.59 / $7.76 / $13.18
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $288.40 / $416.87
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.94 / $85.11 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.94 / $8.91 / $33.11
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
$7.94 / $10.72 / $257.04
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7.59 / $7.59 / $17.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.59 / $125.89 / $134.90