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Wisconsin rates for HCPCS 15152

Tissue cultured skin autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $288.40 / $1,905.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,584.89 / $6,165.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $426.58 / $691.83
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.03 / $302.00 / $3,981.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.83 / $302.00 / $1,737.80
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $363.08 / $512.86
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $354.81 / $891.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,584.89 / $2,137.96