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Vermont rates for HCPCS 15275

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.68 / $151.52 / $249.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.02 / $171.92 / $456.40
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.22 / $215.30 / $456.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.51 / $223.34 / $649.27