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Washington rates for HCPCS 80376

Drug/Substance Definitive Qual/Quant Nos 4-6

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.09 / $112.04 / $112.04
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.09 / $18.68 / $53.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.19 / $24.71 / $34.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $50.00 / $50.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.60 / $48.24 / $142.88
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.09 / $5.09 / $5.09
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.09 / $5.09 / $61.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.58 / $32.34 / $64.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.08 / $10.16 / $25.52
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.56 / $11.56 / $11.56