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Wisconsin rates for HCPCS 15240

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

Facilitymedian $4,266 · 10th–90th $1,660$7,5860%10%10th90th$4,266Professionalmedian $1,175 · 10th–90th $708$3,1620%5%10%10th90th$1,175$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
$660.69 / $1,905.46 / $8,709.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $954.99 / $2,344.23
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
$912.01 / $1,778.28 / $4,073.80
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,454.71 / $2,884.03 / $4,570.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,548.82 / $2,570.40
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$741.31 / $2,137.96 / $5,128.61
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,479.11 / $2,137.96 / $2,754.23
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $2,137.96 / $5,248.07
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $1,621.81 / $5,888.44
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $2,344.23
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,621.81 / $3,890.45 / $4,570.88
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,071.52 / $2,238.72 / $3,467.37
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $2,137.96 / $3,090.30
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
$794.33 / $1,412.54 / $6,760.83
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,445.44 / $1,737.80
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,479.11 / $3,388.44 / $4,168.69
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
$776.25 / $1,258.93 / $3,235.94