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Virginia 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
$119.14 / $3,226.00 / $8,294.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.45 / $109.56 / $156.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.26 / $116.34 / $177.30
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.81 / $77.81 / $916.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.69 / $116.69 / $116.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.73 / $123.14 / $212.20
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.44 / $148.62 / $176.93
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.42 / $118.26 / $198.18
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.00 / $194.00 / $280.50
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.43 / $95.46 / $1,098.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.65 / $172.19 / $1,098.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$296.00 / $1,045.00 / $2,364.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $148.87 / $241.13