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Wyoming rates for HCPCS 15004

Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $389.05 / $676.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $691.83 / $933.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $457.09 / $724.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $524.81 / $3,090.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $489.78 / $1,047.13