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Alaska rates for HCPCS Q4209

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $134.90 / $346.74
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $128.82 / $416.87
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
$3,467.37 / $3,467.37 / $3,467.37
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.82 / $154.88 / $354.81
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $190.55 / $389.05