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West Virginia rates for HCPCS 15240

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $6,606.93 / $28,183.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $812.83 / $1,659.59
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $1,000.00
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $891.25 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,862.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,047.13 / $4,365.16
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $8,317.64 / $8,317.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $5,754.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $891.25 / $1,258.93