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Wisconsin rates for HCPCS Q4218

Surgicord Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.00 / $120.00 / $120.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.00 / $120.00 / $127.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.37 / $127.50 / $142.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$127.50 / $127.50 / $127.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.50 / $127.50 / $127.50
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.00 / $121.50 / $178.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.00 / $121.50 / $180.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $150.00 / $205.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.00 / $120.00 / $178.80
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
$65.00 / $150.00 / $562.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.50 / $127.50 / $570.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.00 / $150.00 / $180.00