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Alaska rates for HCPCS Q4249

Amniply, per sq cm

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,663.99 / $3,663.99 / $3,663.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $1,969.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,787.58
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,789.55 / $3,663.99 / $5,129.59
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,969.89 / $1,969.89 / $2,560.86
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,495.87 / $4,321.92 / $5,942.64
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,296.02 / $2,971.32 / $3,241.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,756.80 / $3,663.99 / $5,129.59
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$966.24 / $1,706.40 / $2,813.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,954.84 / $2,954.84 / $5,909.67