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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
$645.65 / $645.65 / $645.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $645.65 / $1,819.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $457.09 / $616.60
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $645.65 / $1,584.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $645.65 / $1,584.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $50.12 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,888.44 / $5,888.44 / $5,888.44
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $100.00