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Washington rates for HCPCS 95810

Polysom 6/>Yrs Sleep 4/> Addl Param Attnd

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$142.87 / $165.74 / $325.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.67 / $807.14 / $1,460.92
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$110.17 / $142.88 / $316.98
Aetna
Facility/Professional
Professional
Modifier
52
Low / Median / High Price
$247.60 / $360.15 / $576.84
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$442.08 / $664.26 / $1,210.22
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$606.98 / $606.98 / $978.93
Ambetter
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$181.52 / $194.67 / $225.09
Asuris Northwest Health
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$158.58 / $701.13 / $701.13
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$600.61 / $1,010.13 / $6,200.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$120.18 / $214.21 / $2,600.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$507.06 / $843.03 / $7,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$678.68 / $1,134.50 / $1,921.73
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$127.89 / $210.31 / $348.46
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$549.15 / $922.88 / $1,573.26
Kaiser Permanente
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$113.89 / $198.95 / $398.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$559.77 / $882.85 / $1,650.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$108.26 / $176.18 / $319.83
Kaiser Permanente
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$451.82 / $721.72 / $1,320.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.30 / $546.37 / $1,483.54
Pacific Source
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$180.81 / $229.74 / $236.64
Pacific Source
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$131.76 / $184.50 / $256.52
Pacific Source
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$525.49 / $791.16 / $1,072.08
Premera BCBS
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$157.63 / $157.63 / $158.58
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.59 / $1,360.94 / $1,698.09
Premera BCBS
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$166.56 / $264.02 / $316.01
Premera BCBS
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$732.00 / $1,117.00 / $1,383.33
Regence BlueShield
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$1,784.45 / $1,784.45 / $3,043.22
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$622.44 / $655.20 / $1,324.44
Regence BlueShield
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$115.38 / $121.80 / $269.45
Regence BlueShield
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$507.06 / $513.79 / $978.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$688.40 / $1,107.08 / $1,728.74
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$134.55 / $234.51 / $346.56
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$525.99 / $832.47 / $1,417.34
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.29 / $628.27 / $725.13
Wellpoint
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$95.79 / $113.45 / $121.67
Wellpoint
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$423.49 / $514.82 / $603.46