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Massachusetts rates for HCPCS 15275

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$599.54 / $2,547.00 / $4,161.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.61 / $137.75 / $382.10
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.46 / $1,866.13 / $4,755.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.42 / $224.27 / $3,306.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.91 / $138.97 / $245.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.41 / $226.47 / $379.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.96 / $191.91 / $415.76
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.79 / $300.00 / $6,679.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.93 / $221.03 / $305.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.69 / $243.14 / $468.51
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,852.05 / $3,217.80 / $3,885.41
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $2,338.00 / $8,498.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.92 / $280.88 / $3,737.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,640.00 / $3,372.00 / $8,425.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.55 / $242.70 / $545.00