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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
$52.48 / $2,089.30 / $3,801.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $64.57 / $263.03
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $309.03 / $2,818.38
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $91.20 / $223.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.98 / $48.98 / $114.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $91.20 / $194.98
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $177.83 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $117.49 / $169.82
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $2,041.74 / $3,467.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $100.00 / $218.78
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $275.42 / $2,818.38
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $91.20 / $223.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $1,862.09 / $2,818.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $93.33 / $186.21