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Washington rates for HCPCS Q9964

High Osmolar Contrast Material 400 Or Greater Mg/Ml Iodine Concentration Per Ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.33 / $0.38
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $100.00 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.65 / $1.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.28 / $1.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.00 / $75.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.37 / $79,999.20 / $79,999.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.43