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Alaska rates for HCPCS Q4188

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $602.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $691.83
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $588.84 / $1,071.52
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
$741.31 / $1,584.89 / $3,467.37
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,071.52 / $1,174.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $602.56 / $1,071.52
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 / $2,511.89