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Vermont rates for HCPCS 15115

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$704.02 / $828.73 / $1,798.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$749.10 / $1,052.43 / $2,286.21
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$844.63 / $1,168.50 / $2,286.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$844.63 / $1,126.17 / $3,273.87