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Washington rates for HCPCS 76513

Dx Ophthalmic Us Ant Segment Immersion Uni/Bi

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$36.00 / $72.26 / $124.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.04 / $93.64 / $202.52
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$29.75 / $36.00 / $85.08
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$43.62 / $57.65 / $126.80
Asuris Northwest Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$74.77 / $145.31 / $145.31
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.49 / $195.07 / $642.29
Asuris Northwest Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.43 / $76.06 / $335.18
Asuris Northwest Health
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$118.60 / $144.10 / $248.74
Asuris Northwest Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$61.15 / $115.12 / $379.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.51 / $153.31 / $244.12
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$36.79 / $60.42 / $98.28
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$58.34 / $90.77 / $151.29
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$33.79 / $71.70 / $122.43
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.45 / $180.23 / $243.75
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.79 / $70.48 / $89.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$58.90 / $110.29 / $153.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.75 / $69.40 / $221.04
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$49.49 / $63.65 / $68.34
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$40.79 / $58.00 / $73.73
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$67.34 / $91.12 / $122.20
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$42.58 / $42.58 / $43.42
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.63 / $173.12 / $210.89
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$48.97 / $72.42 / $89.04
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$66.50 / $100.62 / $121.85
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$211.40 / $211.40 / $385.75
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.49 / $148.97 / $202.09
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$43.43 / $62.90 / $85.33
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$60.06 / $87.49 / $118.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.50 / $101.41 / $240.03
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$33.47 / $36.81 / $88.92
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$49.41 / $65.86 / $152.90
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.33 / $84.33 / $84.33
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$34.33 / $34.33 / $34.33
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$50.00 / $50.00 / $50.00