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Illinois rates for HCPCS C5276

Low Cost Skin Substitute App

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$735.00 / $1,842.00 / $5,389.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$878.00 / $1,476.00 / $10,073.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $150.00 / $345.40
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.00 / $916.00 / $3,606.00