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Washington, DC 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
$134.90 / $4,073.80 / $5,888.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $107.15 / $190.55
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $426.58 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $123.03 / $223.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $181.97 / $354.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $549.54 / $5,888.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $125.89 / $257.04