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Alaska rates for HCPCS Q4128

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.64 / $55.64 / $55.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.91 / $29.91 / $29.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $42.33
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.70 / $55.64 / $77.90
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $39.95
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.18 / $97.39 / $3,495.87
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.32 / $32.32 / $32.32
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.91 / $55.64 / $97.39
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $36.60 / $38.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.87 / $44.87 / $89.73