go back

Washington rates for HCPCS Q4253

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.37 / $83.37 / $83.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $83.37 / $90.67
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.79 / $969.00 / $1,140.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $1,311.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.50 / $71.50 / $143.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $92.95
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.79 / $75.79 / $102.32
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $102.32
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $75.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.79 / $83.18 / $253.52
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.27 / $946.20 / $946.20
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.57 / $146.47 / $230.97
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.79 / $75.79 / $75.79
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $75.79 / $75.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $90.95
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.79 / $75.79 / $119.43