go back

Wisconsin 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

Facilitymedian $4,169 · 10th–90th $1,202–$6,9180%10%10th90th$4,169Professionalmedian $1,047 · 10th–90th $617–$2,5700%10%10th90th$1,047$50.0$200.0$1.0K$5.0K

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
$575.44 / $1,445.44 / $3,090.30
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $758.58 / $1,737.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $4,570.88 / $7,079.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $1,548.82 / $3,548.13
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,454.71 / $3,890.45
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $1,288.25 / $2,187.76
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $1,905.46 / $3,981.07
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $1,862.09 / $2,398.83
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $1,905.46 / $5,248.07
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,380.38 / $3,981.07
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $2,187.76
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,513.56 / $3,890.45 / $4,570.88
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,949.84 / $3,019.95
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $1,949.84 / $2,818.38
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,801.89 / $3,801.89 / $5,623.41
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $1,148.15 / $5,888.44
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $1,258.93 / $1,479.11
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $2,951.21 / $3,548.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $3,548.13 / $6,918.31
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $1,122.02 / $2,818.38