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Washington rates for HCPCS 12021

Tx Superficial Wound Dehiscence W/Packing

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.21 / $423.58 / $14,464.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.55 / $180.98 / $390.92
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$244.50 / $1,130.00 / $2,499.04
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.20 / $370.22 / $1,316.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$334.00 / $507.81 / $731.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.53 / $263.94 / $479.08
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.20 / $287.10 / $453.73
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.00 / $294.55 / $457.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.26 / $227.72 / $406.26
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.13 / $310.70 / $358.45
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.57 / $239.18 / $244.50
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.75 / $331.62 / $448.17
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$732.75 / $1,129.34 / $2,161.55
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.73 / $276.45 / $426.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.00 / $588.00 / $5,793.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.90 / $262.20 / $535.19
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.33 / $153.33 / $194.77