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Massachusetts rates for HCPCS 15155

Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $2,818.38 / $5,128.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $691.83 / $1,949.84
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $5,754.40 / $28,840.32
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,047.13 / $2,344.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $870.96 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,096.48 / $2,187.76
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $1,445.44 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,148.15 / $1,659.59
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
$794.33 / $1,230.27 / $2,187.76
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $5,754.40 / $28,840.32
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $1,047.13 / $2,398.83
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
$691.83 / $1,047.13 / $2,137.96