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Alaska rates for HCPCS Q4115

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.92 / $23.92 / $23.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.86 / $12.86 / $12.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $18.20
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.48 / $23.92 / $33.49
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $12.86 / $16.72
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.86 / $30.42 / $3,495.87
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.01 / $16.01 / $16.01
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.86 / $23.92 / $33.49
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.86 / $16.30 / $18.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.00 / $19.29 / $38.58