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Washington rates for HCPCS 19303

Mastectomy Simple Complete

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,272.92 / $9,745.37 / $24,636.22
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$6,460.59 / $23,078.03 / $36,714.22
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,735.84 / $18,480.04 / $35,350.23
Asuris Northwest Health
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$17,989.66 / $27,720.06 / $53,627.40
Asuris Northwest Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$867.02 / $1,442.13 / $1,442.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,813.70 / $3,813.70 / $6,353.58
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,208.68 / $2,026.86 / $8,528.74
Kaiser Permanente
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$8,528.74 / $16,807.21 / $40,438.06
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,427.37 / $1,848.54 / $1,949.03
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,296.03 / $1,319.82 / $2,373.40
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,983.48 / $18,469.48 / $35,350.23
Regence BlueShield
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$17,975.22 / $27,704.22 / $53,025.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $3,297.00 / $12,835.00