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Maine 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 $1,122 · 10th–90th $1,122–$1,1220%50%100%$1,122Professionalmedian $117 · 10th–90th $62–$2290%5%10%10th90th$117$50.0$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,122.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $107.15 / $218.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $125.89 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $151.36 / $281.84
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $141.25 / $257.04
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $107.15 / $194.98
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $128.82 / $239.88