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West Virginia rates for HCPCS 15260

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $5,248.07 / $5,248.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $870.96 / $1,778.28
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $1,071.52
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $933.25 / $933.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,412.54 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,071.52 / $4,677.35
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,890.45 / $3,890.45 / $7,943.28
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,288.25 / $1,479.11
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
$691.83 / $954.99 / $1,348.96