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Vermont rates for HCPCS 15240

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$805.56 / $942.01 / $2,115.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.24 / $1,278.78 / $3,767.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.60 / $1,216.88 / $2,669.98
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$988.59 / $1,358.27 / $2,669.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$988.59 / $1,222.93 / $3,831.85