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Wisconsin rates for HCPCS 15130

Dermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children

Facilitymedian $4,266 · 10th–90th $1,230$7,4130%10%10th90th$4,266Professionalmedian $871 · 10th–90th $525$2,2390%10%10th90th$871$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
$501.19 / $1,230.27 / $3,090.30
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $660.69 / $1,513.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,630.27 / $4,570.88 / $7,079.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $1,348.96 / $3,019.95
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,905.46 / $2,187.76 / $3,548.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $1,148.15 / $1,949.84
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $1,621.81 / $3,981.07
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,584.89 / $2,089.30
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$588.84 / $1,621.81 / $7,943.28
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $1,174.90 / $3,388.44
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $1,621.81
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $5,754.40 / $7,762.47
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,621.81 / $2,630.27
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,659.59 / $2,511.89
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
$602.56 / $954.99 / $5,128.61
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,096.48 / $1,348.96
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $2,511.89 / $3,235.94
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,786.30 / $7,413.10 / $9,120.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $954.99 / $2,511.89