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West Virginia rates for HCPCS 15005

Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; each additional 100 sq cm, or part thereof, or each additional 1% of body area of infants and children (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $112.20 / $1,412.54
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $95.50 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.36 / $151.36 / $1,318.26
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$15.14 / $15.14 / $15.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $457.09 / $457.09