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Alaska rates for HCPCS 15240

Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $10,715.19 / $14,125.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $912.01 / $3,801.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.40 / $2,570.40 / $2,951.21
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $912.01 / $5,495.41
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,137.96 / $2,818.38
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $3,235.94 / $4,073.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $1,096.48 / $5,495.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $1,318.26 / $2,818.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $2,398.83 / $3,548.13