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Alaska rates for HCPCS 15130

Dermal autograft, trunk, arms, legs; 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
$1,737.80 / $7,079.46 / $14,125.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $831.76 / $2,818.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $1,949.84 / $2,290.87
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $758.58 / $4,073.80
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,949.84 / $2,511.89
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,398.83 / $3,162.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $831.76 / $4,073.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $1,000.00 / $2,238.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,548.82 / $2,344.23