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California rates for HCPCS Q4108

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.54 / $38.54 / $38.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $42.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.87 / $57.00 / $96.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $49.12 / $107.97
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.84 / $62.09 / $100.00
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.80 / $14.00 / $35.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.36 / $36.36 / $38.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $54.54
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.85 / $44.84 / $60.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.69 / $48.18 / $84.79
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $197.96 / $197.96
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.96 / $197.96 / $199.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.73 / $91.92 / $91.92
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.07 / $38.54 / $62.97
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $58.63
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.85 / $22.62 / $42.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $38.54 / $77.38