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Wisconsin rates for HCPCS Q4116

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

Facilitymedian $33,884 · 10th–90th $31$89,1250%10%10th90th$33,884Professionalmedian $26 · 10th–90th $24$3160%20%10th90th$26$5.0$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$4,168.69 / $37,153.52 / $104,712.85
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.99 / $25.12 / $36.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $213.80 / $446.68
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$41.69 / $79.43 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$31.62 / $77.62 / $125.89
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$25.12 / $30.90 / $44.67
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$25.12 / $30.90 / $100.00
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $30.90 / $30.90
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
$67.61 / $67.61 / $67.61
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $295.12 / $416.87
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $85.11 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $30.90 / $46.77
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $147.91
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
$33.11 / $41.69 / $257.04
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $125.89 / $134.90