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Alaska rates for HCPCS Q4116

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $9,549.93 / $38,018.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $25.70 / $41.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.90 / $30.90 / $30.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $30.90 / $43.65
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.92 / $32.36 / $77.62
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $309.03 / $512.86
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $102.33 / $3,467.37
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $41.69 / $165.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $125.89 / $125.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $109.65 / $323.59