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Rhode Island 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
$2,089.30 / $2,754.23 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $120.23 / $371.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $95.50 / $158.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $141.25 / $288.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $1,412.54 / $6,456.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $123.03 / $239.88