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Washington rates for HCPCS B4083

Stomach Tube - Levine Type (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130 4450)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.91 / $1.91 / $1.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.24 / $1.91 / $2.25
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.27 / $3.60 / $85.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.72 / $1.97 / $2.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.18 / $1.18 / $1.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.19 / $2.19 / $2.68
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.02 / $2.13 / $2.71
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $3.15 / $5.12
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.97 / $1.97 / $4.05
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $3.00 / $5.70
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.72 / $1.72 / $2.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.42 / $5.53