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Alaska rates for HCPCS Q4170

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.12 / $73.12 / $73.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.31 / $39.31 / $39.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.31 / $39.31 / $55.63
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.55 / $73.12 / $104.56
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.31 / $39.31 / $80.78
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,596.00 / $1,824.00 / $3,495.87
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$969.00 / $1,254.00 / $1,368.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.31 / $73.12 / $1,500.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.31 / $158.33 / $900.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.97 / $58.97 / $117.93