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Washington rates for HCPCS D7240

Removal Of Impacted Tooth - Completely Bony

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$433.00 / $6,470.00 / $27,982.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.25 / $203.44 / $433.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,419.07 / $5,062.89 / $5,062.89
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.63 / $1,334.79 / $1,935.08
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.89 / $409.22 / $2,059.66
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.89 / $394.95 / $531.74
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
$290.64 / $425.01 / $466.32
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.63 / $514.71 / $514.71