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Wisconsin rates for HCPCS Q4201

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

Facilitymedian $110 · 10th–90th $76$2880%20%10th90th$110Professionalmedian $79 · 10th–90th $76$3310%20%40%10th90th$79$5.0$20.0$100.0$500.0$2.0K

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
$77.62 / $77.62 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $87.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $269.15 / $446.68
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $208.93 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $125.89 / $223.87
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $77.62 / $169.82
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $93.33
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $81.28 / $288.40
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $79.43 / $331.13
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $58.88 / $70.79
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $109.65 / $109.65
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $89.13 / $144.54
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $302.00 / $446.68
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $288.40 / $371.54
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $87.10 / $407.38
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $204.17
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $125.89 / $151.36