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Alaska rates for HCPCS 15115

Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $7,079.46 / $14,125.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $954.99 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $2,630.27
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $831.76 / $4,897.79
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,089.30 / $2,754.23
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,818.38 / $3,548.13
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $954.99 / $4,897.79
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $1,148.15 / $2,454.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,862.09 / $2,818.38