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Wisconsin rates for HCPCS Q4122

DermACELL, DermACELL AWM or DermACELL AWM Porous, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $120 · 10th–90th $95$3630%20%10th90th$120Professionalmedian $102 · 10th–90th $95$1820%50%10th90th$102$0.1$1.0$10.0$100.0$1.0K

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
$95.50 / $95.50 / $95.50
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $100.00 / $117.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $109.65 / $398.11
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $199.53 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $147.91 / $181.97
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.08 / $97.72 / $147.91
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $120.23 / $457.09
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $109.65 / $457.09
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
$128.82 / $128.82 / $128.82
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $275.42 / $446.68
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $363.08
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $549.54
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
$190.55 / $257.04 / $331.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $120.23 / $281.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $125.89 / $134.90