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Wisconsin rates for HCPCS Q4123

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

Facilitymedian $74 · 10th–90th $58–$1860%20%40%10th90th$74Professionalmedian $72 · 10th–90th $71–$1700%50%10th90th$72$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
$72.44 / $72.44 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $77.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $87.10 / $426.58
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $95.50 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $125.89 / $223.87
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $158.49
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$29.51 / $29.51 / $32.36
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $74.13 / $162.18
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $398.11
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
$39.81 / $39.81 / $39.81
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $204.17 / $416.87
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $89.13 / $309.03
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $81.28 / $363.08
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
$28.84 / $95.50 / $257.04
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $165.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $125.89 / $134.90