go back

Alaska rates for HCPCS Q4247

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,968.00 / $4,968.00 / $4,968.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,128.00 / $3,128.00 / $3,128.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,128.00 / $3,128.00 / $3,128.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.00 / $4,968.00 / $6,955.20
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.00 / $689.00 / $927.50
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,996.40 / $2,281.60 / $3,495.87
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,212.09 / $1,568.60 / $1,711.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.00 / $4,968.00 / $6,955.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.00 / $1,568.60 / $3,128.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,800.00 / $4,800.00 / $9,738.43