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Alaska rates for HCPCS Q4122

DermACELL, DermACELL AWM or DermACELL AWM Porous, per sq cm (add-on, list separately in addition to primary procedure)

Facilitymedian $132 · 10th–90th $69$2290%20%10th90th$132Professionalmedian $102 · 10th–90th $95$3090%50%10th90th$102$0.1$0.5$2.0$10.0$50.0$200.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $100.00 / $120.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $120.23 / $177.83
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $302.00 / $512.86
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $169.82 / $407.38
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $131.83 / $144.54
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $120.23 / $177.83
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $125.89 / $138.04
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $125.89 / $316.23