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Wisconsin rates for HCPCS 15276

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; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Facilitymedian $1,096 · 10th–90th $27–$3,5480%10%10th90th$1,096Professionalmedian $39 · 10th–90th $23–$980%5%10%10th90th$39$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
$19.95 / $50.12 / $1,905.46
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.89 / $30.20 / $66.07
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
$33.11 / $61.66 / $138.04
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $97.72 / $154.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$27.54 / $52.48 / $89.13
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$24.55 / $67.61 / $3,981.07
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $64.57 / $95.50
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$24.55 / $67.61 / $1,737.80
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $64.57 / $158.49
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $891.25 / $2,344.23
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $74.13 / $112.20
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $72.44 / $109.65
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $199.53
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$27.54 / $44.67 / $2,691.53
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $45.71 / $60.26
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $104.71 / $138.04
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
$26.92 / $45.71 / $114.82