go back

Wisconsin rates for HCPCS Q4197

PuraPly XT Antimicrobial 5x5CM EX SHEE 0.1 %

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.81 / $72.81 / $72.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $72.81 / $77.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $106.05
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.79 / $113.12 / $113.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.73 / $233.66 / $331.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $93.66 / $217.95
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $72.81 / $121.98
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.04 / $73.17 / $156.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.04 / $71.04 / $303.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $179.44
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.70 / $72.81 / $121.98
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.69 / $83.25 / $360.05
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.54 / $300.00 / $344.25
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $220.43 / $453.26
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.26 / $99.26 / $99.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.70 / $70.70 / $91.91