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Wisconsin rates for HCPCS Q4150

AlloWrap DS or dry, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $85 · 10th–90th $78$2400%20%40%10th90th$85Professionalmedian $81 · 10th–90th $78$2000%20%10th90th$81$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
$79.43 / $79.43 / $79.43
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $77.62 / $85.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $117.49 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $199.53 / $380.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $125.89 / $223.87
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $81.28 / $177.83
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $95.50
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $87.10 / $186.21
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $85.11 / $177.83
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $54.95 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $91.20
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $91.20 / $147.91
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $269.15 / $416.87
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $85.11 / $380.19
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $89.13 / $380.19
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $128.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $194.98
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $125.89 / $134.90