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Washington rates for HCPCS Q4183

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $85.11 / $85.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $83.18 / $85.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $85.11 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $85.11
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $478.63 / $645.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.25 / $5.25 / $5.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $50.12 / $75.86
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $83.18 / $85.11
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $85.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$125.89 / $125.89 / $125.89
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $131.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $162.18
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $154.88 / $257.04