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Alaska rates for HCPCS 15150

Tissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,872.00 / $7,340.00 / $13,413.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,066.38 / $3,292.63 / $3,359.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,076.41 / $1,180.46 / $2,277.29
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,066.38 / $4,292.93 / $4,702.67
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,547.30 / $1,790.63 / $2,063.07
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,540.85 / $2,598.75 / $3,007.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,066.38 / $4,292.93 / $4,702.67
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,026.80 / $2,118.69 / $4,170.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$906.27 / $1,821.84 / $1,821.84