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Alaska rates for HCPCS Q4132

Grafix Core and GrafixPL Core, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $198.46 / $198.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.70 / $106.70 / $106.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $150.99
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.18 / $198.46 / $283.80
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $106.70 / $160.05
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$206.56 / $789.60 / $1,240.80
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.12 / $620.40 / $676.80
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.70 / $218.31 / $1,128.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.70 / $181.36 / $676.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.05 / $163.01 / $320.10