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Wisconsin rates for HCPCS 15221

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Facilitymedian $1,096 · 10th–90th $85$3,5480%10%10th90th$1,096Professionalmedian $135 · 10th–90th $62$4070%5%10%10th90th$135$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
$56.23 / $138.04 / $3,090.30
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $109.65 / $302.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,584.89 / $6,165.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $208.93 / $489.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $398.11 / $630.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $173.78 / $380.19
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $194.98 / $3,981.07
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $218.78 / $371.54
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $194.98 / $1,659.59
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $234.42 / $1,380.38
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $208.93
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $891.25 / $2,344.23
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $302.00 / $398.11
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $204.17 / $436.52
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $1,995.26 / $1,995.26
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $162.18 / $1,513.56
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $245.47
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $288.40 / $549.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,659.59 / $2,187.76
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $162.18 / $436.52