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Washington rates for HCPCS Q4117

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.95 / $24.39 / $24.39
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.81 / $85.00 / $107.59
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.38 / $109.02 / $129.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.39 / $24.39 / $78.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.39 / $24.39 / $24.39
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.26 / $39.26 / $39.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $50.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.91 / $16.91 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.81 / $23.81 / $24.39
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.09 / $24.39 / $25.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $34.43
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.69 / $28.69 / $28.69