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Wisconsin rates for HCPCS 15275

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Facilitymedian $3,548 · 10th–90th $141$6,6070%10%10th90th$3,548Professionalmedian $191 · 10th–90th $85$5370%10%10th90th$191$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$8.71 / $1,202.26 / $6,309.57
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $151.36 / $389.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $4,570.88 / $7,079.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $263.03 / $602.56
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Typical Low / Median / Typical High
$223.87 / $398.11 / $912.01
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $107.15 / $114.82
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $158.49 / $199.53
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $501.19 / $794.33
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $234.42 / $478.63
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $263.03 / $3,981.07
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $288.40 / $467.74
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $269.15 / $5,128.61
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $288.40 / $741.31
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $295.12
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $3,890.45 / $4,570.88
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $346.74 / $446.68
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $288.40 / $524.81
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $338.84 / $4,073.80
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $199.53 / $3,715.35
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $173.78 / $302.00
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $398.11 / $691.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,570.40 / $3,311.31 / $6,606.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $194.98 / $501.19