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West Virginia rates for HCPCS 15120

Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $1,412.54 / $2,818.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $724.44 / $1,513.56
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $870.96
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $776.25 / $776.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $954.99 / $4,365.16
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $3,981.07 / $10,715.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $2,884.03 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $851.14 / $1,230.27