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Alaska rates for HCPCS Q4126

MemoDerm, DermaSpan, TranZgraft or InteguPly, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.09 / $116.09 / $116.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.41 / $62.41 / $62.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $88.32
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.81 / $116.09 / $162.53
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $62.41 / $93.62
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.87 / $156.00 / $3,495.87
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.22 / $107.25 / $117.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.41 / $116.09 / $195.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.41 / $105.02 / $117.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.62 / $93.62 / $187.23