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Wisconsin rates for HCPCS Q4208

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$384.00 / $384.00 / $384.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$384.00 / $384.00 / $408.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.80 / $384.00 / $456.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.00 / $408.00 / $408.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.00 / $408.00 / $408.00
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$384.00 / $388.80 / $572.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$384.00 / $388.80 / $576.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $1,008.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $136.13
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$384.00 / $384.00 / $572.16
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,900.00 / $5,900.00 / $5,900.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$408.00 / $456.00 / $1,800.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.00 / $508.80 / $1,824.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$480.00 / $480.00 / $604.79