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West Virginia rates for HCPCS 15136

Dermal 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
$86.27 / $92.03 / $1,400.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.58 / $89.37 / $96.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.77 / $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
$78.29 / $114.71 / $252.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.26 / $118.96 / $163.13