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Washington rates for HCPCS Q4113

Graftjacket Xpress

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$762.88 / $762.88 / $762.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$718.00 / $762.88 / $762.88
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.02 / $744.92 / $3,365.63
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$762.88 / $3,410.50 / $4,038.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$762.88 / $762.88 / $3,018.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$762.88 / $762.88 / $762.88
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$528.38 / $1,224.35 / $1,865.77
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.38 / $1,320.66 / $1,892.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $75.00 / $919.55
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$919.55 / $919.55 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$308.95 / $412.75 / $762.88
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.08 / $762.88 / $807.75
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$350.58 / $350.58 / $385.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,997.50 / $1,997.50 / $2,397.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$718.00 / $718.00 / $718.00