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Wisconsin rates for HCPCS Q4191

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

Facilitymedian $933 · 10th–90th $661$3,5480%20%10th90th$933Professionalmedian $661 · 10th–90th $200$3,0900%50%10th90th$661$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$676.08 / $676.08 / $676.08
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $724.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $2,570.40 / $5,370.32
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $2,630.27 / $4,570.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $223.87 / $1,202.26
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $676.08 / $1,479.11
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,122.02
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $758.58 / $1,621.81
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $724.44 / $1,737.80
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $58.88 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,621.81 / $1,621.81
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,071.52 / $1,737.80
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $302.00 / $3,235.94
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $1,479.11 / $4,466.84
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $741.31 / $4,466.84
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $891.25 / $1,096.48
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $933.25 / $2,187.76
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $933.25