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Arizona rates for HCPCS 15221

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Facilitymedian $2,344 · 10th–90th $324–$6,7610%5%10%10th90th$2,344Professionalmedian $110 · 10th–90th $59–$3160%5%10%10th90th$110$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
$1,737.80 / $3,715.35 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $109.65 / $354.81
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $1,230.27 / $2,238.72
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $87.10 / $269.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $112.20 / $173.78
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $128.82 / $1,905.46
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $144.54 / $1,513.56
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $1,122.02 / $2,187.76
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $109.65 / $162.18