go back

Wisconsin rates for HCPCS Q4217

WoundFix, BioWound, WoundFix Plus, BioWound Plus, WoundFix Xplus or BioWound Xplus, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$327.54 / $327.54 / $327.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.00 / $327.54 / $349.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.00 / $318.00 / $572.40
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$435.37 / $508.80 / $508.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$498.64 / $912.20 / $1,292.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.02 / $348.33 / $1,384.39
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.00 / $327.54 / $547.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.00 / $327.54 / $700.73
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.00 / $318.00 / $1,452.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.00 / $327.54 / $547.54
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.00 / $423.94 / $1,633.22
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$273.51 / $1,232.50 / $2,027.14
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.00 / $1,232.50 / $1,994.29
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.47 / $446.47 / $446.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.00 / $318.00 / $413.40