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Vermont rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.04 / $68.98 / $121.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.45 / $84.70 / $237.55
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.70 / $101.04 / $237.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.29 / $111.33 / $323.64