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Washington 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 $263 · 10th–90th $126$10,7150%10%10th90th$263Professionalmedian $135 · 10th–90th $62$3390%10%10th90th$135$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$138.04 / $691.83 / $17,782.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $120.23 / $363.08
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,148.15 / $1,148.15 / $1,148.15
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $169.82 / $302.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $562.34 / $912.01
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $177.83 / $371.54
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $173.78 / $323.59
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $177.83 / $331.13
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $56.23
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $245.47 / $257.04
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $177.83 / $177.83
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $177.83 / $316.23
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$912.01 / $912.01 / $1,148.15
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $162.18 / $275.42
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $645.65 / $5,754.40
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $165.96 / $281.84
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $117.49 / $194.98