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California rates for HCPCS Q4111

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $7.95 / $24.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.95 / $24.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.94 / $8.26 / $13.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.12 / $7.87 / $19.73
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.77 / $17.48 / $19.05
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.20 / $6.00 / $15.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.43 / $7.43 / $7.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $9.65
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.99 / $7.33 / $9.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.08 / $9.84 / $17.30
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.39 / $32.39 / $32.39
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.68 / $15.02 / $15.02
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.57 / $7.95 / $13.22
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $9.32
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.74 / $15.74 / $15.74
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.30 / $6.99 / $8.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $14.91