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Washington rates for HCPCS D4260

Osseous Surgery (Including Elevation Of A Full Thickness Flap And Closure) - Four Or More Contiguous Teeth Or Tooth Bounded Spaces Per Quadrant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$509.69 / $509.69 / $509.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.08 / $500.98 / $509.69
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,442.95 / $16,547.20 / $16,547.20
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$911.00 / $2,436.69 / $3,154.80
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$490.38 / $979.27 / $1,951.21
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.47 / $916.31 / $1,177.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $50.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$593.79 / $694.62 / $724.27
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$999.90 / $1,220.61 / $1,220.61
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$687.00 / $687.00 / $687.00