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Wyoming rates for HCPCS 15115

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$712.76 / $712.76 / $829.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,232.00 / $1,642.00 / $1,911.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$826.81 / $1,060.23 / $1,498.71
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
$920.06 / $1,393.25 / $2,445.29