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Alaska rates for HCPCS Q4159

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $213.80 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $204.17 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $204.17 / $288.40
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $245.47 / $537.03
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
$354.81 / $2,041.74 / $3,467.37
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,380.38 / $1,513.56
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $323.59 / $1,380.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $125.89 / $125.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $446.68 / $2,691.53