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Maryland 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 $912 · 10th–90th $912–$2,3990%20%40%90th$912Professionalmedian $107 · 10th–90th $59–$2340%10%10th90th$107$50.0$100.0$200.0$500.0$1.0K$2.0K

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
$912.01 / $1,258.93 / $2,398.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $107.15 / $309.03
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $74.13 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $112.20 / $213.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $158.49 / $281.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $151.36 / $151.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $114.82 / $199.53
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $141.25 / $218.78