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Massachusetts rates for HCPCS 15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.62 / $1,845.24 / $3,625.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.67 / $697.55 / $1,460.28
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,089.00 / $3,315.28 / $8,498.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.55 / $1,186.10 / $4,435.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$726.70 / $944.71 / $1,667.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$929.28 / $1,304.34 / $1,929.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.32 / $1,157.50 / $2,314.19
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$611.83 / $1,325.06 / $6,679.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$856.96 / $1,080.21 / $1,491.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$755.71 / $1,569.46 / $2,368.78
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,103.34 / $3,103.34 / $3,103.34
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,640.00 / $4,200.78 / $16,394.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$838.37 / $1,453.06 / $5,573.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,450.00 / $3,592.00 / $8,498.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$688.42 / $1,126.14 / $2,211.09