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Washington rates for HCPCS A7504

Filter For Use In A Tracheostoma Heat And Moisture Exchange System Each (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.54 / $1.23 / $1.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.54 / $1.30
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.84 / $80.00 / $80.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.69 / $0.85 / $4.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.57 / $0.57 / $0.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.49 / $0.71
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.90 / $1.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.95 / $1.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.74 / $0.93 / $0.95
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.95 / $0.95
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $0.84 / $1.54
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.79 / $0.90 / $1.37
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.81 / $1.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.48 / $0.77
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.62