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Alaska rates for HCPCS 15200

Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,345.55 / $10,175.36 / $13,413.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$665.27 / $3,232.22 / $3,957.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,156.46 / $1,429.97 / $2,668.17
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,232.22 / $4,525.10 / $5,540.46
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,648.05 / $1,977.66 / $2,458.02
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,630.13 / $2,849.12 / $3,574.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,232.22 / $4,525.10 / $5,540.46
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,156.46 / $2,417.50 / $4,421.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$909.33 / $2,134.54 / $3,220.18