go back

Wisconsin rates for HCPCS Q4205

Membrane Graft or Membrane Wrap, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $1,288 · 10th–90th $389$3,6310%20%10th90th$1,288Professionalmedian $1,230 · 10th–90th $200$2,9510%20%10th90th$1,230$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
$1,288.25 / $1,288.25 / $1,288.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,348.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,479.11 / $2,398.83 / $5,128.61
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $2,754.23 / $4,677.35
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $223.87 / $1,348.96
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,288.25 / $2,754.23
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,288.25 / $1,288.25
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $1,230.27 / $2,754.23
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,202.26 / $2,511.89
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
$1,230.27 / $1,548.82 / $1,548.82
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,230.27 / $1,949.84
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $302.00 / $3,090.30
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,412.54 / $5,128.61
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,288.25 / $5,248.07
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $1,659.59 / $2,041.74
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $2,454.71
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $1,047.13