go back

Washington rates for HCPCS Q4122

DermACELL, DermACELL AWM or DermACELL AWM Porous, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $102.85 / $102.85
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.23 / $85.32 / $453.75
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $459.80 / $544.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.85 / $102.85 / $205.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.85 / $102.85 / $102.85
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.33 / $118.33 / $118.33
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.66 / $132.66 / $132.66
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
$79,999.20 / $79,999.20 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.00 / $76.18 / $102.85
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.17 / $102.85 / $108.90
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.90 / $74.90 / $82.39
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.10 / $49.10 / $86.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $132.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.00 / $110.00 / $110.00