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Massachusetts rates for HCPCS 15241

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 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
$142.21 / $2,663.12 / $4,712.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.54 / $142.21 / $233.85
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$252.22 / $941.10 / $4,142.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.98 / $256.11 / $1,775.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.13 / $158.77 / $280.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.68 / $213.00 / $454.85
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.44 / $300.00 / $6,679.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.77 / $240.21 / $331.58
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.66 / $273.42 / $469.96
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$519.32 / $1,818.00 / $26,542.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.94 / $346.61 / $1,925.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$627.00 / $1,818.00 / $2,733.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.61 / $252.20 / $469.61