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Washington rates for HCPCS D7210

Extraction, Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.00 / $232.00 / $10,634.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.21 / $107.20 / $232.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,254.48 / $3,728.65 / $3,728.65
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.77 / $728.46 / $1,073.93
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.90 / $212.42 / $2,059.66
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.90 / $201.47 / $272.58
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
$161.91 / $236.85 / $2,303.00
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.77 / $275.62 / $275.62