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Vermont rates for HCPCS 15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$617.83 / $782.34 / $1,623.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$897.14 / $1,089.26 / $3,337.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$658.68 / $932.74 / $2,215.73
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$819.20 / $1,125.40 / $2,215.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$819.20 / $1,092.27 / $3,175.30