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Wisconsin rates for HCPCS Q4151

Amnioband Or Guardian Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.93 / $138.93 / $138.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $138.93 / $148.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $209.07
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.67 / $214.48 / $215.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$187.38 / $342.79 / $485.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $173.81 / $257.52
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.88 / $138.93 / $212.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.19 / $141.31 / $216.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.19 / $137.19 / $288.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.88 / $138.93 / $212.56
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $163.91 / $444.64
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.47 / $181.54 / $633.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $202.95 / $633.20
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.39 / $189.39 / $189.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.88 / $134.88 / $175.36