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Vermont rates for HCPCS 15260

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$874.62 / $1,020.70 / $1,265.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,111.46 / $1,349.46 / $3,942.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$917.10 / $1,307.09 / $2,869.52
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,064.91 / $1,463.51 / $2,869.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,064.91 / $1,329.12 / $4,127.68