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Restorigin

Wisconsin rates for HCPCS Q4191

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

Rates data updated July 2026.

Facilitymedian $1,000 · 10th–90th $389$3,9810%20%10th90th$1,000Professionalmedian $724 · 10th–90th $126$3,5480%20%10th90th$724$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
Setting
Facility
Modifier
Global
Typical Low
$676.08
Median
$676.08
Typical High
$676.08
Aetna
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$676.08
Typical High
$794.33
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,548.82
Median
$2,570.40
Typical High
$5,370.32
Cigna
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$2,630.27
Typical High
$3,890.45
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$223.87
Typical High
$1,202.26
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$660.69
Median
$676.08
Typical High
$1,479.11
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$1,122.02
Typical High
$1,122.02
Medica
Setting
Facility
Modifier
Global
Typical Low
$724.44
Median
$758.58
Typical High
$1,621.81
Medica
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$724.44
Typical High
$1,737.80
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$58.88
Typical High
$85.11
Network Health
Setting
Facility
Modifier
Global
Typical Low
$1,071.52
Median
$1,621.81
Typical High
$1,621.81
Network Health
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,071.52
Typical High
$1,737.80
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$660.69
Median
$676.08
Typical High
$1,479.11
Quartz
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$302.00
Typical High
$3,235.94
Quartz
Setting
Facility
Modifier
Global
Typical Low
$1,479.11
Median
$1,479.11
Typical High
$3,981.07
Quartz
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$144.54
Typical High
$3,467.37
Security Health
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$891.25
Typical High
$1,096.48
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$295.12
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$169.82