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Oregon 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
$138.04 / $288.40 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $117.49 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $173.78 / $323.59
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $141.25 / $316.23
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $165.96 / $331.13
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $218.78 / $309.03
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $245.47 / $257.04
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $151.36 / $288.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $169.82 / $323.59
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $234.42 / $323.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $4,073.80 / $6,165.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $177.83 / $331.13