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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
$101.36 / $253.62 / $3,119.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,183.00 / $3,483.00 / $5,962.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$694.76 / $811.89 / $1,245.45
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.85 / $284.58 / $711.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.84 / $344.02 / $5,169.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.85 / $284.58 / $711.48
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.29 / $454.50 / $845.97
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$237.84 / $317.87 / $579.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,960.00 / $4,155.00 / $5,865.00