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Massachusetts rates for HCPCS 15111

Epidermal autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.00 / $2,079.00 / $3,625.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$241.78 / $941.10 / $4,142.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.73 / $149.15 / $263.19
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.33 / $300.00 / $6,679.00
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$483.03 / $1,818.00 / $12,000.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.00 / $1,818.00 / $2,733.00