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Washington rates for HCPCS 15840

Graft for facial nerve paralysis; free fascia graft (including obtaining fascia)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $7,943.28 / $20,892.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $1,288.25 / $4,677.35
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $2,344.23 / $9,549.93
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,949.84 / $2,041.74
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,380.38
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,760.83 / $10,232.93 / $19,498.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $12,022.64 / $20,417.38