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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)

Facilitymedian $3,715 · 10th–90th $646–$8,3180%10%10th90th$3,715Professionalmedian $110 · 10th–90th $59–$2190%20%10th90th$110$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$724.44 / $3,801.89 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $109.65 / $218.78
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $2,570.40 / $57,543.99
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $117.49 / $199.53
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $208.93 / $229.09
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $158.49 / $223.87
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $2,570.40 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $109.65 / $269.15
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $234.42 / $549.54
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $138.04 / $407.38
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $125.89 / $407.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $575.44 / $4,466.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $112.20 / $204.17