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Wisconsin rates for HCPCS 15271

Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $316.23 / $3,090.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $141.25 / $316.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,570.88 / $7,079.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $245.47 / $588.84
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.33 / $102.33 / $102.33
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $151.36 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $478.63 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $213.80 / $416.87
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $239.88 / $3,981.07
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $269.15 / $446.68
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $239.88 / $5,248.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $257.04 / $2,570.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $251.19
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $263.03 / $524.81
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $5,623.41
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $177.83 / $3,019.95
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $354.81 / $660.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,754.23 / $3,630.78 / $6,456.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $181.97 / $501.19