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Alaska rates for HCPCS 15260

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,606.93 / $14,125.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,047.13 / $3,019.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $2,818.38 / $3,235.94
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $1,174.90 / $5,888.44
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,238.72 / $3,019.95
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $3,388.44 / $4,365.16
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $1,174.90 / $5,888.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $1,412.54 / $3,019.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $2,570.40 / $3,890.45