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Washington rates for HCPCS Q4224

Human Health Factor 10 Amniotic Patch (HHF10-P), per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $60.00 / $60.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.50 / $34.50 / $34.50