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Wisconsin rates for HCPCS Q4185

Cellesta Flowable Amnion (25 mg per cc); per 0.5 cc

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.62 / $588.62 / $588.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.62 / $588.62 / $1,646.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$781.33 / $781.33 / $781.33
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.62 / $588.62 / $900.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.62 / $588.62 / $1,646.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.62 / $588.62 / $1,059.52
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
$65.00 / $65.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$781.33 / $781.33 / $781.33