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Washington rates for HCPCS Q4183

Surgigraft Per Square Centimeter

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.00 / $85.00 / $85.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.00 / $100.00 / $375.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $380.00 / $450.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $170.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.30 / $5.30 / $5.30
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
$83.00 / $83.00 / $85.00
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.00 / $85.00 / $90.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.91 / $160.91 / $193.10
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00