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Washington 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
$8.66 / $14.24 / $14.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $8.58 / $9.84
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.02 / $11.00 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.74 / $7.87 / $32.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.43 / $7.43 / $15.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $9.65
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.87 / $10.61 / $19.72
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $10.62 / $19.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.12 / $60.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7.12 / $7.87 / $14.81
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.11 / $7.87 / $17.19
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.74 / $7.95 / $14.17
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.95 / $7.87 / $7.87
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.48 / $7.87 / $7.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.87 / $7.87 / $9.44
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7.33 / $7.87 / $7.87