go back

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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.69 / $362.42 / $17,100.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.97 / $139.46 / $353.43
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.86 / $311.83 / $16,394.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.44 / $210.02 / $1,510.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.00 / $906.00 / $906.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.77 / $172.94 / $341.94
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.00 / $170.71 / $319.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.80 / $175.82 / $335.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.11 / $150.05 / $267.18
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.69 / $247.99 / $268.00
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.86 / $176.86 / $177.58
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.44 / $180.66 / $324.19
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$908.79 / $908.79 / $1,144.93
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.79 / $178.99 / $299.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.00 / $588.00 / $5,793.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.12 / $206.55 / $382.15
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.98 / $71.98 / $141.05