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Vermont rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.02 / $290.08 / $602.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$233.24 / $362.72 / $988.70
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.57 / $490.46 / $988.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.11 / $481.92 / $1,524.02