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California rates for HCPCS Q4121

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.75 / $53.28 / $135.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $53.28 / $135.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.61 / $56.69 / $95.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.85 / $53.00 / $115.23
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.58 / $57.69 / $100.00
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.50 / $25.00 / $71.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.77 / $49.77 / $52.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $52.75 / $55.93
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.96 / $48.45 / $65.41
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.48 / $65.94 / $116.05
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $213.92 / $213.92
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.92 / $213.92 / $213.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.15 / $99.32 / $99.32
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.75 / $54.86 / $88.79
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $52.75 / $60.56
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.86 / $88.86 / $88.86
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.96 / $42.20 / $58.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.75 / $52.75 / $95.80