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Wisconsin rates for HCPCS 15040

Harvest of skin for tissue cultured skin autograft, 100 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $251.19 / $3,090.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,570.88 / $7,079.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $812.83 / $1,288.25
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $354.81 / $3,981.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.03 / $363.08 / $5,248.07
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $398.11 / $891.25
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $5,623.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $3,801.89 / $6,606.93