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Massachusetts rates for HCPCS 15201

Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $2,754.23 / $4,897.79
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $1,995.26 / $28,840.32
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $87.10 / $204.17
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $501.19 / $7,079.46
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $2,041.74 / $3,467.37
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $1,698.24
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $1,995.26 / $28,840.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $1,862.09 / $2,818.38