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Wisconsin rates for HCPCS Q4130

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.01 / $5.01 / $5.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.01 / $5.01 / $100.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $323.59 / $776.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $151.36 / $181.97
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.62 / $5.62 / $25.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.62 / $5.62 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $295.12 / $416.87
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $100.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $147.91
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $302.00 / $331.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $134.90