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Alaska rates for HCPCS Q4194

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $676.08 / $831.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $933.25
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $794.33 / $1,348.96
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $309.03 / $537.03
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,584.89 / $3,467.37
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,096.48 / $1,202.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $831.76 / $1,348.96
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