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Massachusetts rates for HCPCS 15200

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.87 / $2,663.12 / $4,712.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.71 / $738.20 / $1,395.50
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,313.00 / $3,402.71 / $9,151.39
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$640.84 / $1,287.15 / $4,868.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$798.21 / $1,037.67 / $1,831.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,008.43 / $1,451.13 / $2,094.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$747.77 / $1,227.49 / $2,539.00
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$672.87 / $1,455.46 / $6,679.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$931.24 / $1,172.22 / $1,618.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$834.76 / $1,726.43 / $2,554.37
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,704.71 / $4,527.85 / $9,984.53
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.00 / $3,764.00 / $26,542.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$881.56 / $1,568.12 / $6,049.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.00 / $3,764.00 / $8,766.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.60 / $1,159.54 / $2,268.07