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Alaska rates for HCPCS Q4150

AlloWrap DS or dry, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $81.28 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $109.65
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $93.33 / $158.49
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.25 / $302.00 / $512.86
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $128.82 / $3,467.37
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $89.13
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.62 / $144.54 / $208.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $125.89 / $125.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $190.55 / $354.81