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Wisconsin rates for HCPCS Q4210

Axolotl Graft or Axolotl DualGraft, per sq cm

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $2,089.30 / $3,090.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,348.96 / $1,548.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $954.99 / $2,398.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $3,162.28 / $3,162.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $58.88 / $58.88
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $1,698.24
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $851.14 / $1,819.70
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,630.78 / $3,630.78 / $3,630.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $851.14 / $851.14