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Massachusetts rates for HCPCS 15121

Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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
$159.82 / $2,663.12 / $4,712.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.31 / $941.10 / $4,142.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.38 / $196.81 / $347.29
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.00 / $300.00 / $6,679.00
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.00 / $1,818.00 / $26,542.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.00 / $1,818.00 / $2,733.00