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Wisconsin rates for HCPCS Q4183

Surgigraft Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.00 / $80.00 / $85.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.00 / $85.00 / $95.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $81.00 / $119.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $81.00 / $120.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.91 / $160.91 / $337.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $119.20
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
$85.00 / $100.00 / $375.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $106.00 / $380.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.91 / $160.91 / $202.76