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Washington rates for HCPCS D9951

Occlusal Adjustment - Limited

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.53 / $54.53 / $54.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.92 / $47.20 / $54.53
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$441.60 / $885.11 / $885.11
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.00 / $283.32 / $371.55
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.60 / $102.33 / $2,059.66
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.60 / $90.62 / $116.44
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
$56.71 / $84.46 / $856.52
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.69 / $197.39 / $197.39