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Alaska rates for HCPCS 15220

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 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
$532.95 / $782.34 / $3,635.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,060.11 / $1,327.40 / $2,450.19
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,936.89 / $4,111.64 / $5,089.03
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,491.98 / $1,790.37 / $2,253.27
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,476.37 / $2,579.31 / $3,309.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,936.89 / $4,111.64 / $5,089.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,060.11 / $2,208.75 / $4,066.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$835.24 / $1,960.16 / $2,957.11