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Wisconsin rates for HCPCS 15261

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

Facilitymedian $1,148 · 10th–90th $174–$3,9810%5%10%10th90th$1,148Professionalmedian $234 · 10th–90th $123–$6310%5%10%10th90th$234$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
$112.20 / $275.42 / $3,090.30
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $177.83 / $478.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,630.27 / $6,165.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $380.19 / $831.76
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $630.96 / $1,000.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $295.12 / $562.34
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $363.08 / $3,981.07
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $371.54 / $602.56
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $363.08 / $1,659.59
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $371.54 / $2,089.30
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $416.87
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$281.84 / $891.25 / $2,344.23
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $467.74 / $630.96
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $389.05 / $676.08
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $1,995.26 / $1,995.26
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $295.12 / $2,290.87
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $389.05
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $562.34 / $870.96
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
$144.54 / $263.03 / $676.08