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Washington rates for HCPCS 19301

Mastectomy Partial

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,206.24 / $9,963.42 / $18,800.00
Aetna
Facility/Professional
Facility
Modifier
22
Low / Median / High Price
$670.34 / $670.34 / $11,101.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$4,815.00 / $12,900.00 / $25,596.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.09 / $836.19 / $1,897.20
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$585.21 / $807.13 / $1,298.44
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,126.02 / $10,802.03 / $26,542.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$10,306.59 / $16,203.05 / $31,346.52
Asuris Northwest Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$497.14 / $826.90 / $826.90
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$920.63 / $1,569.94 / $5,859.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,186.71 / $2,186.71 / $3,643.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$802.54 / $1,357.32 / $1,991.05
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$809.87 / $1,377.14 / $6,433.53
Kaiser Permanente
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$6,433.53 / $9,505.52 / $22,870.24
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$816.90 / $1,310.50 / $2,454.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.23 / $266.72 / $1,354.61
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.54 / $1,257.58 / $1,335.31
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$894.22 / $910.80 / $1,239.50
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$937.51 / $1,519.26 / $1,868.04
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,004.63 / $10,795.86 / $20,663.07
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$10,506.95 / $16,193.79 / $30,994.61
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$911.99 / $1,310.20 / $1,764.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,550.00 / $2,431.00 / $11,261.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$819.58 / $1,395.40 / $1,910.73