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Washington rates for HCPCS Q4194

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$729.99 / $729.99 / $729.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $729.99 / $782.38
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.63 / $1,215.45 / $3,792.20
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $4,000.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$626.05 / $626.05 / $1,438.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $813.88
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.63 / $663.63 / $895.90
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $829.54
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
$663.63 / $717.78 / $1,489.73
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$830.00 / $830.00 / $1,012.88
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$931.84 / $1,012.88 / $1,661.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$663.63 / $663.63 / $663.63
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.45 / $663.63 / $663.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $796.36
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.63 / $663.63 / $858.92