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Alaska rates for HCPCS Q4110

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.65 / $121.65 / $121.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.40 / $65.40 / $65.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.40 / $65.40 / $92.55
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.41 / $121.65 / $170.31
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.41 / $65.41 / $95.24
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.72 / $151.91 / $208.89
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.81 / $104.45 / $113.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.41 / $121.65 / $189.90
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.40 / $78.48 / $113.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.12 / $98.12 / $196.23