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Utah 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 $3,388 · 10th–90th $141–$4,8980%10%20%10th90th$3,388Professionalmedian $117 · 10th–90th $63–$2140%10%10th90th$117$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
$141.25 / $3,388.44 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $117.49 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $114.82 / $208.93
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $323.59
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $134.90 / $229.09
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $134.90 / $251.19
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $162.18 / $234.42
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $112.20 / $173.78