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Idaho 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
$1,628.00 / $4,500.00 / $7,205.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.73 / $109.56 / $199.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.43 / $124.57 / $217.24
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.41 / $116.58 / $227.30
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.94 / $133.26 / $244.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $196.72
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.86 / $141.25 / $241.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,800.00 / $8,244.00 / $9,193.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.69 / $182.36 / $236.43