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Wisconsin rates for HCPCS Q4128

Flex Hd Or Allopatch Hd Per Square Centimeter (Desc Revised 10/01/2022)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.81 / $30.81 / $31,920.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $30.81 / $32.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $44.86
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.95 / $47.56 / $47.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.83 / $74.70 / $105.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.69 / $31.17 / $54.46
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.91 / $30.81 / $47.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.70 / $31.62 / $56.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.70 / $30.70 / $64.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.91 / $30.81 / $47.14
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $37.92 / $95.35
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.87 / $75.00 / $135.06
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $48.98 / $135.06
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.99 / $41.99 / $41.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $35.89