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Alaska rates for HCPCS Q4137

AmnioExcel, AmnioExcel Plus or BioDExcel, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.19 / $189.19 / $189.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.72 / $101.72 / $101.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.72 / $101.72 / $143.94
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.72 / $189.19 / $270.54
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.72 / $101.72 / $147.78
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$176.13 / $432.91 / $3,495.87
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.57 / $297.63 / $324.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.72 / $189.19 / $541.14
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.72 / $129.13 / $324.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.58 / $152.58 / $305.16