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Wyoming rates for HCPCS 15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$731.29 / $731.29 / $888.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,268.00 / $1,690.00 / $2,053.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$824.82 / $1,102.03 / $1,554.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,275.00 / $1,275.00 / $5,606.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$956.90 / $1,490.41 / $2,689.41