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Massachusetts rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.69 / $2,079.00 / $3,625.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.31 / $57.46 / $121.39
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.19 / $627.00 / $2,733.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.75 / $109.72 / $3,050.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.51 / $64.36 / $122.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.46 / $95.53 / $217.34
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.94 / $168.26 / $6,679.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.48 / $110.38 / $152.36
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.66 / $112.59 / $215.92
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $966.90 / $3,445.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.65 / $129.22 / $3,512.93
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
$77.51 / $109.72 / $241.10