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Alaska rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.64 / $14.64 / $14.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $7.87 / $7.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $11.14
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.12 / $14.64 / $20.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $10.23
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.06 / $24.83 / $3,495.87
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.74 / $7.74 / $7.74
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $14.64 / $21.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $8.69 / $2,250,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.81 / $11.81 / $23.61