go back

Alaska rates for HCPCS Q4203

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,071.52 / $1,318.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,047.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $1,479.11
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,148.15 / $2,137.96
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
$478.63 / $1,584.89 / $3,467.37
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,096.48 / $1,202.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $1,096.48 / $2,137.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $125.89 / $125.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $446.68 / $2,511.89