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Ohio 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
$105.33 / $2,785.00 / $9,516.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.89 / $109.56 / $199.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$772.00 / $2,141.00 / $3,111.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.78 / $116.39 / $228.23
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.26 / $96.48 / $96.48
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.15 / $128.18 / $128.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21,571.00 / $21,571.00 / $21,571.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.66 / $114.20 / $215.18
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.20 / $116.19 / $204.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.79 / $110.13 / $155.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.00 / $975.00 / $2,914.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.61 / $140.07 / $230.26