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Wisconsin rates for HCPCS 15101

Split-thickness 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)

Facilitymedian $1,148 · 10th–90th $145–$7,5860%5%10%10th90th$1,148Professionalmedian $347 · 10th–90th $195–$6610%10%10th90th$347$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $218.78 / $6,456.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,168.69 / $6,165.95 / $7,585.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $562.34 / $912.01
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $309.03 / $5,128.61
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $309.03 / $1,659.59
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $891.25 / $2,344.23
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $346.74 / $660.69
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $2,951.21 / $2,951.21
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $204.17 / $354.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,659.59 / $3,311.31