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Alaska rates for HCPCS Q4195

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.17 / $182.17 / $182.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $97.94 / $97.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $138.59
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.92 / $182.17 / $255.04
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $97.94 / $214.85
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$217.16 / $330.24 / $500.03
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.31 / $227.04 / $247.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $224.99 / $412.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.94 / $198.00 / $247.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.91 / $146.91 / $293.82