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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
$549.54 / $776.25 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,047.13 / $2,344.23
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,318.26 / $1,318.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,047.13 / $1,862.09