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Washington rates for HCPCS A4301

Implantable Access Total Catheter Port/Reservoir (E.G. Venous Arterial Epidural Or Subarachnoid Peritoneal Etc.) (Updated 01-01-2003)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.49 / $78.29 / $81.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.33 / $34.49 / $59.67
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $950.51 / $950.51
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.43 / $11.20 / $75.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.02 / $2.02 / $2.02
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.73 / $22.73 / $22.73