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West Virginia rates for HCPCS 15111

Epidermal 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
$100.00 / $109.65 / $1,412.54
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $107.15 / $134.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.78 / $173.78 / $1,318.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $457.09 / $457.09