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Texas 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 $2,291 · 10th–90th $120$6,9180%5%10th90th$2,291Professionalmedian $115 · 10th–90th $60$2190%10%10th90th$115$50.0$200.0$1.0K$5.0K$20.0K

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
$707.95 / $2,818.38 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $117.49 / $218.78
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $758.58 / $3,981.07
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $112.20 / $190.55
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $56.23 / $128.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $125.89 / $208.93
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $28,840.32 / $28,840.32
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,584.89 / $1,584.89 / $1,584.89
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $154.88 / $3,890.45
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $123.03 / $263.03
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $57.54
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$58.88 / $117.49 / $199.53
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $125.89 / $223.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $954.99 / $2,290.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $104.71 / $173.78
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $134.90