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Alaska rates for HCPCS Q4190

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $114.82 / $208.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $112.20 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $112.20 / $158.49
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.20 / $141.25 / $295.12
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $309.03 / $562.34
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $1,548.82 / $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
$112.20 / $177.83 / $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
$177.83 / $389.05 / $2,041.74