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Wisconsin rates for HCPCS Q4121

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

Facilitymedian $74 · 10th–90th $49–$2140%20%10th90th$74Professionalmedian $54 · 10th–90th $52–$1410%50%10th90th$54$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
$53.70 / $53.70 / $53.70
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $57.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $70.79 / $134.90
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $123.03 / $213.80
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $123.03 / $138.04
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $117.49
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $47.86 / $53.70
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$48.98 / $50.12 / $213.80
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 / $50.12 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$47.86 / $47.86 / $51.29
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $51.29 / $87.10
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
$169.82 / $169.82 / $213.80
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $60.26 / $223.87
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
$47.86 / $70.79 / $257.04
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $120.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $125.89 / $134.90