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Alaska rates for HCPCS Q4239

Amnio-maxx or lite per sq cm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,538.88 / $3,538.88 / $3,538.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $1,902.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $2,692.39
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,038.50 / $3,538.88 / $4,954.43
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $1,902.62 / $2,473.41
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,495.87 / $4,320.00 / $5,940.00
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,295.00 / $2,970.00 / $3,240.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.62 / $3,538.88 / $5,400.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.62 / $2,957.64 / $3,240.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,853.93 / $2,853.93 / $5,707.86