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Wisconsin rates for HCPCS 68328

Conjunctpl Cul-De-Sac W/Buccal Muc Memb Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,052.31 / $2,589.02 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,740.00 / $4,780.00 / $7,344.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,859.91 / $2,173.44 / $3,505.70
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.64 / $969.22 / $1,437.30
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$742.22 / $4,103.00 / $8,384.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.64 / $969.22 / $1,860.01
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,254.59 / $1,656.07 / $2,350.69
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,819.45 / $5,819.45 / $5,819.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,614.00 / $6,477.00 / $8,384.00