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Washington 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
$98.72 / $98.72 / $98.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.75 / $92.44 / $98.72
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.75 / $1,417.80 / $1,668.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.78 / $89.75 / $1,668.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.67 / $84.67 / $143.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.75 / $89.75 / $110.07
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.75 / $89.75 / $121.16
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.75 / $89.75 / $121.16
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
$76.47 / $89.75 / $169.63
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.82 / $1,384.44 / $1,384.44
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.65 / $90.04 / $141.97
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.75 / $89.75 / $89.75
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.26 / $89.75 / $89.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.75 / $89.75 / $107.70
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.42 / $89.75 / $89.75