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Alaska rates for HCPCS Q4180

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,220.39 / $1,220.39 / $1,220.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.12 / $656.12 / $656.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $928.48
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,090.07 / $1,220.39 / $1,745.16
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$656.12 / $656.12 / $1,075.64
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,335.19 / $2,668.80 / $3,669.60
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,417.80 / $1,834.80 / $2,001.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$656.12 / $1,220.39 / $1,900.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.99 / $711.83 / $2,084.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$984.18 / $984.18 / $1,968.36