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Wisconsin rates for HCPCS 15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less

Facilitymedian $4,169 · 10th–90th $1,349$7,0790%5%10%10th90th$4,169Professionalmedian $891 · 10th–90th $550$2,3440%5%10%10th90th$891$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
$512.86 / $2,089.30 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $758.58 / $1,819.70
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
$741.31 / $1,445.44 / $3,235.94
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
$630.96 / $1,230.27 / $2,089.30
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $1,659.59 / $3,981.07
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,621.81 / $2,290.87
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $1,659.59 / $5,128.61
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $1,348.96 / $4,570.88
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $1,819.70
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $3,890.45 / $4,570.88
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $1,737.80 / $2,691.53
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,737.80 / $2,570.40
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
$616.60 / $1,122.02 / $5,623.41
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,445.44
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $2,570.40 / $3,311.31
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $3,548.13 / $6,918.31
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $1,023.29 / $2,630.27