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Wisconsin rates for HCPCS 15131

Dermal autograft, trunk, arms, legs; 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 $1,148 · 10th–90th $79–$3,9810%5%10%10th90th$1,148Professionalmedian $123 · 10th–90th $76–$3090%10%10th90th$123$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
$72.44 / $177.83 / $1,905.46
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $91.20 / $218.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,630.27 / $6,165.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $186.21 / $426.58
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $288.40 / $457.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $154.88 / $281.84
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $239.88 / $3,981.07
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $229.09 / $295.12
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $239.88 / $1,737.80
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $169.82 / $467.74
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $263.03
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $891.25 / $2,344.23
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $229.09 / $398.11
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $234.42 / $338.84
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $223.87 / $891.25
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $141.25 / $758.58
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $162.18 / $177.83
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $371.54 / $446.68
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,659.59 / $3,311.31
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $138.04 / $354.81