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Wisconsin rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Facilitymedian $1,148 · 10th–90th $66$3,5480%10%10th90th$1,148Professionalmedian $83 · 10th–90th $40$2630%5%10th90th$83$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
$34.67 / $87.10 / $3,162.28
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $70.79 / $208.93
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
$69.18 / $131.83 / $302.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $245.47 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $109.65 / $208.93
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $125.89 / $3,981.07
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $138.04 / $229.09
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $125.89 / $1,737.80
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $131.83 / $363.08
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $128.82
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $891.25 / $2,344.23
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $147.91 / $229.09
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $138.04 / $281.84
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $107.15 / $275.42
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $89.13 / $3,548.13
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $81.28 / $154.88
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $181.97 / $338.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,584.89 / $2,187.76
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $93.33 / $234.42