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West Virginia rates for HCPCS 15201

Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.66 / $5,640.00 / $5,640.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.58 / $90.79 / $98.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$129.19 / $129.19 / $129.19