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Wisconsin rates for HCPCS 15110

Epidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.79 / $1,440.34 / $3,119.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,740.00 / $4,780.00 / $7,344.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,153.67 / $2,516.73 / $3,860.75
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$687.71 / $1,065.77 / $2,330.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$696.36 / $1,655.63 / $5,169.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$687.71 / $1,065.77 / $2,330.04
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,458.50 / $1,980.00 / $2,750.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,350.72 / $1,805.22 / $3,331.88
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,976.00 / $4,155.00 / $5,865.00