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Wisconsin rates for HCPCS 15200

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

Facilitymedian $4,467 · 10th–90th $1,445$7,7620%10%10th90th$4,467Professionalmedian $1,000 · 10th–90th $617$2,5120%5%10%10th90th$1,000$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
$562.34 / $5,248.07 / $8,128.31
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$562.34 / $776.25 / $1,698.24
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
$794.33 / $1,584.89 / $3,548.13
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,187.76 / $2,570.40 / $4,168.69
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $1,380.38 / $2,511.89
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $1,819.70 / $5,128.61
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,778.28 / $2,454.71
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $1,819.70 / $7,762.47
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,445.44 / $5,011.87
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $1,949.84
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $5,754.40 / $7,762.47
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $1,905.46 / $2,951.21
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,905.46 / $2,884.03
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,801.89 / $5,623.41 / $5,623.41
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $1,230.27 / $6,025.60
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,230.27 / $1,548.82
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $2,818.38 / $3,630.78
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
$676.08 / $1,122.02 / $2,818.38