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Washington rates for HCPCS Q9965

Low Osmolar Contrast Material 100-199 Mg/Ml Iodine Concentration Per Ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.05 / $16.32 / $927.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $1.05 / $2.13
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.96 / $100.00 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $0.96 / $527.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $0.90 / $1.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $1.18
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.96 / $1.27 / $2.48
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $1.30 / $2.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.98 / $70.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.96 / $1.80 / $3.74
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $0.76 / $0.76
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $0.76 / $2.34
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.96 / $0.96 / $0.96
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $0.96 / $1.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.96 / $0.96 / $1.14