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Alaska rates for HCPCS 15100

Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,872.00 / $7,340.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.68 / $3,443.76 / $4,113.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,223.54 / $1,467.77 / $2,769.31
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,443.76 / $4,821.26 / $5,758.66
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,753.18 / $2,103.81 / $2,538.54
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,731.56 / $3,030.86 / $3,687.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,443.76 / $4,821.26 / $5,758.66
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,223.54 / $2,566.25 / $4,691.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$943.92 / $2,215.46 / $3,342.25