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Alaska rates for HCPCS Q4101

Apligraf, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.40 / $56.40 / $1,085.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $56.23 / $56.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $30.23 / $30.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $42.78
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.30 / $56.23 / $78.72
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $30.23 / $39.52
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.00 / $87.06 / $186.69
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.16 / $59.85 / $65.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $59.85 / $120.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.23 / $37.88 / $65.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.35 / $46.18 / $92.00