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Alaska rates for HCPCS Q4108

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.69 / $71.69 / $71.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.54 / $38.54 / $38.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $54.54
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.12 / $71.69 / $100.37
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $57.67
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.04 / $117.49 / $161.55
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.95 / $80.77 / $88.12
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.54 / $76.92 / $146.86
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $56.29 / $88.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.81 / $57.81 / $115.62