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Wisconsin rates for HCPCS 15121

Split-thickness 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 $1,445 · 10th–90th $174–$7,5860%5%10%10th90th$1,445Professionalmedian $398 · 10th–90th $234–$7240%10%10th90th$398$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
$109.65 / $416.87 / $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
$537.03 / $630.96 / $1,000.00
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $371.54 / $5,128.61
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $354.81 / $1,659.59
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
$234.42 / $398.11 / $724.44
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$323.59 / $1,995.26 / $1,995.26
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $245.47 / $398.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,659.59 / $3,311.31