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Alaska rates for HCPCS 15120

Split-thickness 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 (except 15050)

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
$660.69 / $870.96 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $2,754.23
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $851.14 / $4,786.30
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,949.84 / $2,630.27
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,818.38 / $3,715.35
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $954.99 / $4,786.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $1,148.15 / $2,570.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $2,187.76 / $3,311.31