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Washington rates for HCPCS D7220

Removal Of Impacted Tooth - Soft Tissue

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $257.04 / $257.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $131.83 / $257.04
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $302.00 / $5,128.61
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $269.15 / $338.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $50.12 / $64.57
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.42 / $269.15 / $281.84
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $275.42 / $275.42