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West Virginia rates for HCPCS 15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.76 / $705.31 / $1,600.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.95 / $662.72 / $796.20
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$586.57 / $703.88 / $766.89
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.68 / $681.68 / $681.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,024.71 / $1,024.71 / $1,024.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$574.05 / $802.72 / $1,953.39
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,486.99 / $6,486.99 / $6,486.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,225.00 / $1,225.00 / $1,225.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.75 / $958.35 / $1,626.10