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Washington rates for HCPCS A2009

Symphony, per sq cm (add-on, list separately in addition to primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.14 / $75.14 / $75.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.74 / $75.14 / $102.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.94 / $104.09 / $164.36
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.13 / $383.50 / $493.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.13 / $93.13 / $186.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.13 / $93.13 / $93.13
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.45 / $65.51 / $118.95
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
$154.00 / $184.97 / $184.97
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.94 / $90.94 / $93.13
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.37 / $93.13 / $98.61
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$148.40 / $155.40 / $210.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.30 / $91.30 / $98.70
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.72 / $1.72 / $1.72