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Wisconsin rates for HCPCS 15155

Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less

Facilitymedian $6,918 · 10th–90th $1,202$12,0230%10%10th90th$6,918Professionalmedian $1,023 · 10th–90th $617$2,5700%10%10th90th$1,023$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
$602.56 / $1,479.11 / $3,090.30
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$602.56 / $741.31 / $1,819.70
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $7,762.47 / $12,589.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $1,513.56 / $3,388.44
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,398.83 / $3,801.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $1,288.25 / $2,344.23
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $1,949.84 / $3,981.07
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,318.26 / $1,905.46 / $2,398.83
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $1,995.26 / $10,964.78
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $1,258.93 / $3,715.35
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $1,862.09
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,412.54 / $8,511.38 / $9,120.11
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $1,819.70 / $3,235.94
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,949.84 / $2,818.38
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,585.78 / $7,585.78 / $11,220.18
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $1,148.15 / $5,754.40
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,318.26 / $1,318.26 / $1,479.11
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $3,090.30 / $3,630.78
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
$660.69 / $1,122.02 / $2,818.38