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Massachusetts rates for HCPCS 15131

Dermal 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
$65.86 / $2,079.00 / $3,625.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.46 / $81.79 / $113.38
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.16 / $941.10 / $4,142.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.73 / $148.71 / $640.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.98 / $133.87 / $236.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.08 / $143.87 / $329.78
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.54 / $300.00 / $6,679.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.86 / $132.55 / $182.97
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.18 / $215.28 / $290.35
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.76 / $1,818.00 / $12,000.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.64 / $168.78 / $758.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.00 / $1,818.00 / $3,445.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.95 / $135.13 / $253.18