go back

Wisconsin rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $83 · 10th–90th $62–$2450%20%10th90th$83Professionalmedian $65 · 10th–90th $62–$2000%20%10th90th$65$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
$64.57 / $64.57 / $64.57
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $61.66 / $72.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $81.28 / $186.21
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $199.53 / $380.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $125.89 / $223.87
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $64.57 / $141.25
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $66.07 / $66.07
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $61.66 / $141.25
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $125.89
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
$63.10 / $83.18 / $83.18
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $63.10 / $102.33
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $269.15 / $416.87
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $85.11 / $263.03
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $70.79 / $288.40
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $85.11 / $104.71
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $147.91
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $125.89 / $134.90