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Alaska rates for HCPCS Q4235

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $91.20 / $162.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $125.89
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.71 / $162.18 / $234.42
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $302.00 / $512.86
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $3,467.37
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $81.28 / $85.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $144.54 / $229.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $125.89 / $125.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $190.55 / $354.81