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Alaska rates for HCPCS Q4176

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.50 / $256.50 / $256.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.50 / $161.50 / $161.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.50 / $161.50 / $161.50
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.92 / $256.50 / $359.10
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.00 / $222.00 / $222.00
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$266.00 / $304.00 / $3,495.87
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.50 / $209.00 / $228.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.92 / $256.50 / $380.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.50 / $203.25 / $228.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.27 / $255.91 / $502.53