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West Virginia rates for HCPCS 15276

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; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.90 / $31.23 / $1,400.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.26 / $28.54 / $32.79
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.45 / $29.46 / $32.10
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.54 / $28.54 / $28.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.41 / $42.41 / $42.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.78 / $35.67 / $89.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.92 / $42.00 / $63.12