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Massachusetts rates for HCPCS 15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$699.00 / $1,919.00 / $4,834.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$569.37 / $784.92 / $1,884.36
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,089.00 / $3,315.28 / $8,498.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.59 / $1,328.97 / $5,155.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$845.64 / $1,099.33 / $1,939.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$821.08 / $1,301.94 / $2,699.35
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$713.50 / $1,541.94 / $6,679.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$958.31 / $1,204.15 / $1,662.20
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$888.01 / $1,826.90 / $2,668.70
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$594.94 / $2,788.20 / $3,863.50
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,123.33 / $1,123.33 / $2,052.69
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,640.00 / $3,597.37 / $16,394.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$950.22 / $1,613.52 / $6,224.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,640.00 / $3,592.00 / $8,425.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$784.70 / $1,234.08 / $2,329.46