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Alaska rates for HCPCS Q4250

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,541.97 / $5,541.97 / $5,541.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $2,979.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.55 / $2,979.55 / $4,216.35
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,901.66 / $5,541.97 / $7,758.76
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,979.56 / $2,979.56 / $3,694.65
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,495.87 / $4,560.00 / $6,270.00
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,422.50 / $3,135.00 / $3,420.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,979.56 / $5,541.97 / $7,758.76
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,695.00 / $3,232.54 / $3,562.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,469.34 / $4,469.34 / $8,938.68