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Alaska rates for HCPCS Q4191

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,218.85 / $1,218.85 / $1,218.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $655.29 / $655.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $927.31
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$730.43 / $1,218.85 / $1,742.97
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $655.29 / $1,998.10
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,534.06 / $2,800.00 / $3,850.00
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,452.50 / $1,925.00 / $2,100.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$655.29 / $1,218.85 / $3,500.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.29 / $1,515.58 / $2,100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$982.95 / $982.95 / $1,965.90