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Wisconsin rates for HCPCS Q4211

Amnion Bio Or Axobiomembrane Per Square Centimeter

Insurance Carrier
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.93 / $143.93 / $143.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $85.00
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 / $65.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.93 / $143.93 / $143.93