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Massachusetts rates for HCPCS 15120

Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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
$645.65 / $2,754.23 / $5,128.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $870.96 / $2,290.87
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $5,754.40 / $28,840.32
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,096.48 / $2,454.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,862.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,513.56 / $2,290.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,148.15 / $2,398.83
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $1,348.96 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,174.90 / $1,698.24
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,248.07 / $11,220.18
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,202.26 / $2,290.87
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$354.81 / $758.58 / $2,951.21
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $5,754.40 / $28,840.32
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,096.48 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $5,248.07 / $11,220.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,122.02 / $2,238.72