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Washington rates for HCPCS D5730

Reline Complete Maxillary Denture (Direct)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$182.35 / $182.35 / $182.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.51 / $153.77 / $182.35
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.91 / $919.62 / $919.62
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.00 / $1,009.33 / $1,505.93
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.62 / $262.23 / $360.05
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.16 / $262.23 / $368.42
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
$283.18 / $331.38 / $345.72
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.79 / $323.22 / $323.22