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Wisconsin rates for HCPCS 15120

Split-thickness 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 (except 15050)

Facilitymedian $7,586 · 10th–90th $1,549–$12,0230%5%10%10th90th$7,586Professionalmedian $1,122 · 10th–90th $631–$2,5700%5%10%10th90th$1,122$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
$707.95 / $1,659.59 / $12,022.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $891.25 / $2,041.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $7,943.28 / $12,589.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,584.89 / $3,548.13
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,238.72 / $2,570.40 / $4,168.69
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,348.96 / $2,238.72
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $1,862.09 / $3,981.07
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $1,819.70 / $2,454.71
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $1,862.09 / $10,964.78
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,479.11 / $5,128.61
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $2,041.74
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,380.38 / $8,511.38 / $9,120.11
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
$1,202.26 / $1,949.84 / $2,884.03
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,585.78 / $11,220.18 / $11,220.18
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $1,230.27 / $6,165.95
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $1,258.93 / $1,548.82
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,513.56 / $2,884.03 / $3,715.35
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,309.57 / $10,232.93 / $12,022.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $1,174.90 / $2,951.21