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Vermont rates for HCPCS 15120

Split-thickness 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 (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $870.96 / $2,290.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,047.13 / $2,454.71
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,412.54 / $1,412.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,148.15 / $1,995.26