go back

Wisconsin rates for HCPCS Q4124

Oasis Tri-Layer Wound Matrix

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.56 / $2.56 / $2.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.56 / $2.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $3.73
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.41 / $3.96 / $3.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.27 / $22.44 / $31.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $11.58 / $16.45
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.48 / $2.56 / $4.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.48 / $2.56 / $5.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.48 / $2.48 / $16.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.48 / $2.56 / $4.61
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $3.88 / $25.34
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $75.00 / $85.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $14.46 / $5,398.28
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.50 / $3.50 / $3.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $3.41