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Connecticut 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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.43 / $4,769.00 / $7,629.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.55 / $118.11 / $219.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,315.00 / $5,646.00 / $7,714.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.34 / $116.31 / $195.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.43 / $128.57 / $250.61
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.72 / $171.45 / $179.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,347.00 / $3,983.00 / $6,832.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.92 / $166.44 / $273.67