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West Virginia rates for HCPCS 15274

Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.46 / $78.16 / $1,400.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.52 / $62.71 / $86.10
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.51 / $52.70 / $57.43
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.05 / $51.05 / $51.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.58 / $74.58 / $74.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.54 / $79.87 / $183.95
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,402.02 / $8,402.02 / $8,402.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.83 / $93.24 / $130.90