go back

West Virginia rates for HCPCS 15101

Split-thickness autograft, trunk, arms, legs; each additional 100 sq cm, 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
Facility
Modifier
Low / Median / High Price
$107.53 / $174.92 / $1,700.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.13 / $131.22 / $142.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $186.21 / $186.21
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,826.60 / $2,826.60 / $2,826.60