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Washington rates for HCPCS A2004

Misc W/Motor Score 12-32

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.26 / $13.26 / $13.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.48 / $13.26 / $13.26
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.95 / $80.00 / $552.50
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.26 / $1,391.41 / $1,391.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.26 / $13.26 / $26.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.26 / $13.26 / $13.26
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.45 / $65.51 / $118.95
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,218.21 / $1,218.21 / $1,218.21
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
$21.45 / $25.76 / $744.37
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.95 / $12.95 / $13.26
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.01 / $13.26 / $14.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.00 / $13.00 / $15.60
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.65 / $13.65 / $13.65