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Alaska rates for HCPCS 15277

Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$970.49 / $7,340.00 / $13,413.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.66 / $1,110.61 / $1,637.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.45 / $564.03 / $1,096.52
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,110.61 / $1,588.19 / $2,292.40
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$539.38 / $647.25 / $989.79
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$532.11 / $967.15 / $1,432.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,110.61 / $1,588.19 / $2,292.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.06 / $859.50 / $1,577.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.80 / $877.22 / $877.22