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Michigan 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
$102.33 / $2,884.03 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $107.15 / $218.78
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $64.57 / $102.33
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.38 / $97.72 / $102.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $109.65 / $331.13
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $1,348.96 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $144.54 / $213.80
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $104.71 / $275.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $1,258.93 / $2,041.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $120.23 / $173.78