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Massachusetts rates for HCPCS 15004

Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.94 / $1,845.24 / $3,693.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.25 / $340.43 / $684.42
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$604.40 / $1,052.09 / $3,445.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$127.70 / $127.70 / $127.70
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.32 / $578.21 / $1,884.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$299.72 / $389.64 / $687.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.02 / $514.55 / $1,085.34
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$261.24 / $546.52 / $6,679.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.43 / $542.91 / $749.43
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.89 / $671.25 / $1,068.49
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$727.99 / $838.52 / $982.93
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.41 / $291.41 / $774.25
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.00 / $1,818.00 / $16,394.00
Mass General Brigham
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$127.70 / $127.70 / $127.70
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.58 / $720.49 / $2,824.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.00 / $1,818.00 / $2,733.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$379.66 / $570.10 / $1,008.99