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Washington rates for HCPCS 69637

Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [PORP], total ossicular replacement prosthesis [TORP])

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,957.79 / $6,470.00 / $24,827.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,866.94 / $16,595.73 / $31,745.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,147.74 / $4,147.74 / $6,910.09
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,791.30 / $3,030.54 / $11,234.92
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,939.94 / $2,641.14 / $2,906.32
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,929.00 / $1,959.23 / $2,513.62
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,761.59 / $16,586.25 / $31,745.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $3,509.00 / $17,644.00