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Alaska rates for HCPCS Q4106

Dermagraft, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.67 / $60.67 / $60.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.94 / $44.94 / $44.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.94 / $44.94 / $63.60
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.94 / $60.67 / $84.94
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.23 / $58.42 / $78.65
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.78 / $127.95 / $3,495.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.94 / $60.67 / $124.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.78 / $36.51 / $44.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.41 / $76.41 / $152.82