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Washington rates for HCPCS 27122

Acetabuloplasty; resection, femoral head (eg, Girdlestone procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,030.22 / $4,500.00 / $20,680.40
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,522.27 / $35,815.01 / $70,064.83
Asuris Northwest Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$154.96 / $507.73 / $507.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$765.00 / $870.49 / $870.49
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,055.95 / $2,170.63 / $3,025.46
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,551.34 / $2,123.90 / $2,231.77
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,484.03 / $1,484.03 / $1,522.27
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27,977.90 / $36,627.79 / $70,064.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,028.00 / $5,547.00 / $19,271.00