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New York 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 $3,715 · 10th–90th $138$8,5110%10%10th90th$3,715Professionalmedian $120 · 10th–90th $62$3160%10%20%10th90th$120$50.0$200.0$1.0K$5.0K$20.0K

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
$104.71 / $3,090.30 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $117.49 / $316.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,630.27 / $4,786.30 / $9,549.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $134.90 / $309.03
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $1,698.24 / $6,165.95
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $1,659.59 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $134.90 / $316.23
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $91.20 / $223.87
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $190.55 / $288.40
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $138.04 / $234.42
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $117.49
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $204.17 / $398.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,318.26 / $2,511.89 / $4,897.79
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $120.23 / $302.00
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $72.44 / $263.03
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $147.91 / $302.00