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West Virginia rates for HCPCS 15131

Dermal 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
$86.27 / $92.89 / $1,400.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.44 / $89.37 / $98.06
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.78 / $106.52 / $116.06
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.16 / $103.16 / $103.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.97 / $151.97 / $151.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.23 / $115.75 / $265.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$460.00 / $460.00 / $460.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.00 / $125.85 / $176.45