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Wisconsin rates for HCPCS Q4124

OASIS ultra tri-layer wound matrix, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $9 · 10th–90th $2–$850%10%10th90th$9Professionalmedian $2 · 10th–90th $2–$1260%50%90th$2$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $2.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.59 / $12.59 / $19.95
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12.30 / $22.91 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.33 / $125.89 / $223.87
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.51 / $2.57 / $5.75
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.22 / $11.22 / $11.22
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.45 / $2.57 / $75.86
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.45 / $2.45 / $16.22
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
$9.77 / $9.77 / $10.72
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10.47 / $10.72 / $17.38
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $223.87 / $446.68
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.51 / $85.11 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.51 / $2.82 / $5,370.32
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
$3.39 / $4.17 / $257.04
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.12 / $9.12 / $21.38
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.12 / $125.89 / $134.90