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Washington rates for HCPCS 14021

Adjt/Rearrgmt Scalp/Arm/Leg 10.1-30.0 Sq Cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,137.46 / $2,476.21 / $17,930.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.54 / $907.90 / $2,067.17
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,195.06 / $5,167.93 / $11,429.12
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$994.08 / $1,841.98 / $6,464.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.92 / $1,110.00 / $2,323.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$864.46 / $1,338.17 / $2,400.48
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$951.98 / $1,461.04 / $2,184.52
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$999.50 / $1,494.22 / $2,233.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.23 / $469.33 / $1,736.19
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,134.65 / $1,619.48 / $1,752.05
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$759.83 / $1,156.06 / $1,195.06
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$999.69 / $1,659.68 / $2,190.59
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,351.17 / $5,167.93 / $9,885.68
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$956.80 / $1,383.57 / $2,088.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$629.00 / $1,120.00 / $6,857.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,063.28 / $1,418.12 / $2,629.60
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$775.75 / $775.75 / $966.35