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West Virginia rates for HCPCS 15151

Tissue cultured skin autograft, trunk, arms, legs; additional 1 sq cm to 75 sq cm (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.65 / $117.49 / $1,412.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $104.71 / $190.55
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $114.82 / $144.54
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $128.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $186.21 / $1,318.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $144.54 / $758.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $457.09 / $457.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $138.04 / $194.98