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West Virginia rates for HCPCS 15241

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 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
$101.06 / $160.96 / $1,700.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.51 / $150.86 / $179.27
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.98 / $125.98 / $137.25
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.00 / $122.00 / $122.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.74 / $180.74 / $180.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.67 / $171.65 / $466.83
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,530.70 / $7,530.70 / $7,530.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.00 / $206.76 / $292.36