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Wisconsin rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Facilitymedian $4,169 · 10th–90th $513$6,9180%10%10th90th$4,169Professionalmedian $380 · 10th–90th $204$9550%5%10%10th90th$380$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
$181.97 / $446.68 / $3,090.30
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $309.03 / $691.83
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
$323.59 / $616.60 / $1,318.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$891.25 / $1,047.13 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $512.86 / $1,000.00
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $616.60 / $3,981.07
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $616.60 / $1,000.00
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $630.96 / $5,248.07
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $575.44 / $1,584.89
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $616.60
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $3,890.45 / $4,570.88
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $660.69 / $1,000.00
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $645.65 / $1,202.26
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,801.89 / $3,801.89 / $5,623.41
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $398.11 / $2,454.71
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $645.65
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$489.78 / $912.01 / $1,445.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $3,548.13 / $6,918.31
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $436.52 / $1,071.52