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Wisconsin rates for HCPCS 15116

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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 $1,096 · 10th–90th $126–$3,5480%10%10th90th$1,096Professionalmedian $380 · 10th–90th $219–$5370%10%10th90th$380$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
$112.20 / $269.15 / $1,905.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,584.89 / $6,165.95
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $446.68 / $707.95
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $363.08 / $3,981.07
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $363.08 / $1,737.80
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$263.03 / $891.25 / $2,344.23
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $380.19 / $537.03
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $338.84 / $912.01
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $269.15 / $295.12
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,659.59 / $3,311.31