go back

Pennsylvania 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
$121.97 / $2,543.00 / $8,017.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.95 / $107.95 / $172.66
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,299.82 / $2,746.00 / $13,822.74
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.06 / $128.74 / $128.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.56 / $116.18 / $201.69
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.30 / $193.24 / $199.74
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$657.00 / $3,077.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.63 / $116.69 / $1,056.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.90 / $109.90 / $115.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.69 / $116.69 / $116.69
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.92 / $117.04 / $209.10
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.02 / $88.84 / $137.24
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.02 / $123.25 / $135.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.00 / $650.00 / $4,300.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.05 / $143.74 / $249.80