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West Virginia rates for HCPCS 15275

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$147.91 / $3,162.28 / $7,413.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $123.03 / $213.80
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $120.23 / $151.36
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $295.12 / $346.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $158.49 / $158.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $154.88 / $741.31
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $1,949.84 / $10,471.29
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,230.27 / $2,041.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $144.54 / $251.19