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Wisconsin rates for HCPCS Q4113

GRAFTJACKET XPRESS, injectable, 1 cc

Facilitymedian $1,000 · 10th–90th $724–$2,6920%20%10th90th$1,000Professionalmedian $741 · 10th–90th $724–$1,9950%50%10th90th$741$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
$724.44 / $724.44 / $724.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $741.31 / $776.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $758.58 / $977.24
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,778.28 / $2,951.21
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,023.29 / $2,630.27
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$691.83 / $758.58 / $1,096.48
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $707.95
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $891.25 / $1,288.25
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $1,995.26 / $3,388.44
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
$2,137.96 / $2,137.96 / $2,137.96
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $1,862.09 / $1,862.09
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $562.34 / $562.34
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $2,691.53
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $4,073.80
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,230.27 / $1,513.56
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $1,995.26 / $4,677.35
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $1,995.26 / $2,089.30