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Kansas 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
$164.18 / $3,637.00 / $10,439.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $111.08 / $175.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.48 / $94.69 / $176.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$442.00 / $442.00 / $442.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.56 / $129.62 / $210.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.53 / $159.28 / $2,819.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.27 / $163.44 / $1,510.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.00 / $550.00 / $1,769.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.13 / $153.02 / $206.75