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California rates for HCPCS Q4258

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.75 / $89.75 / $90.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.75 / $89.75 / $98.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.54 / $95.63 / $161.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.41 / $89.75 / $206.84
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.31 / $100.00 / $102.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.67 / $84.67 / $89.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.75 / $89.75 / $103.34
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.23 / $73.42 / $99.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.78 / $112.19 / $197.45
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,417.80 / $1,668.00 / $1,668.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,668.00 / $1,884.84 / $1,884.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.35 / $99.11 / $150.51
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.75 / $92.44 / $152.59
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.75 / $89.75 / $125.69
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.23 / $71.80 / $98.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.75 / $89.75 / $180.19