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Wisconsin rates for HCPCS Q4151

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

Facilitymedian $141 · 10th–90th $135–$3890%50%10th90th$141Professionalmedian $138 · 10th–90th $135–$2690%50%10th90th$138$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
$138.04 / $138.04 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $134.90 / $147.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $190.55 / $380.19
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $302.00 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $173.78 / $263.03
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $138.04 / $302.00
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $158.49 / $158.49
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $141.25 / $302.00
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $288.40
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $64.57 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $141.25 / $151.36
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $151.36 / $245.47
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $295.12 / $416.87
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $138.04 / $630.96
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $151.36 / $630.96
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $223.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $316.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $144.54