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Wisconsin rates for HCPCS A2016

PermeaDerm B, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $74.13 / $74.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $91.20 / $120.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $323.59 / $776.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $151.36 / $181.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $58.88 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $288.40 / $416.87
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $100.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $147.91 / $147.91
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $190.55 / $338.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $134.90