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Wisconsin rates for HCPCS C5276

Low Cost Skin Substitute App

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,894.00 / $1,894.00 / $17,823.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,139.00 / $1,183.00 / $1,530.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,100.00 / $1,449.00 / $2,090.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $65.00 / $70.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,034.00 / $1,495.00 / $2,202.90