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Alaska rates for HCPCS 15101

Split-thickness autograft, trunk, arms, legs; each additional 100 sq cm, 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
$0.65 / $1,348.96 / $14,125.38
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $165.96 / $1,230.27
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $194.98 / $870.96