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Washington rates for HCPCS 15101

Split Agrft T/A/L Ea 100 Cm/Ea 1% Bdy Inft/Chld

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$201.30 / $490.29 / $18,711.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.09 / $501.09 / $26,542.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.92 / $1,110.00 / $1,110.00
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.00 / $250.69 / $436.92
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.03 / $343.85 / $375.36
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.09 / $254.09 / $255.95
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,488.56 / $3,488.56 / $4,395.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.00 / $588.00 / $5,793.00