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Washington rates for HCPCS 28264

Capsulotomy Midtarsal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,197.99 / $2,106.75 / $14,464.32
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,701.16 / $4,554.63 / $11,784.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$466.83 / $568.48 / $1,985.59
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$864.00 / $1,528.97 / $2,414.64
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,172.63 / $1,658.17 / $1,928.52
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.44 / $1,196.43 / $1,613.81
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,434.81 / $4,589.03 / $8,891.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $4,016.00 / $16,315.00