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Washington rates for HCPCS Q4128

Flex Hd Or Allopatch Hd Per Square Centimeter (Desc Revised 10/01/2022)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.90 / $32.90 / $32.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $32.90 / $33.46
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.91 / $85.00 / $135.06
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.58 / $29.91 / $135.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.22 / $28.22 / $48.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $36.68
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.91 / $29.91 / $40.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $40.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.47 / $50.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.91 / $30.70 / $56.53
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.33 / $32.32 / $55.69
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.32 / $33.19 / $59.16
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.91 / $29.91 / $35.18
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.41 / $29.91 / $29.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $35.89
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.91 / $29.91 / $30.59