go back

West Virginia rates for HCPCS 15121

Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; 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
$129.02 / $196.70 / $1,700.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.97 / $154.76 / $168.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$220.67 / $220.67 / $220.67