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Alaska rates for HCPCS Q4133

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,551.14 / $7,551.14 / $7,551.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $258.06 / $258.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.74 / $138.74 / $138.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $196.33
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.18 / $258.06 / $361.28
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $138.74 / $180.36
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.44 / $452.21 / $621.79
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.58 / $310.89 / $339.16
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.74 / $283.87 / $565.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.74 / $171.20 / $339.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.11 / $211.95 / $422.22