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Massachusetts rates for HCPCS 15276

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; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.72 / $2,083.00 / $3,685.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.16 / $29.34 / $51.89
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $627.00 / $2,733.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.36 / $50.35 / $2,298.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.03 / $36.44 / $64.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.22 / $46.16 / $92.24
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.00 / $168.26 / $6,679.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.81 / $44.43 / $61.34
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.31 / $62.46 / $88.91
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
$37.29 / $58.16 / $2,685.33
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
$32.92 / $47.84 / $84.86