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Wisconsin rates for HCPCS Q4139

Amniomatrix Or Biodmatrix Injectable 1 Cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.00 / $640.00 / $640.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.00 / $640.00 / $1,820.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.26 / $424.92 / $603.39
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.00 / $640.00 / $1,152.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.00 / $640.00 / $1,152.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.00 / $640.00 / $1,152.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,900.00 / $5,900.00 / $5,900.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $65.00 / $100.00