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Washington rates for HCPCS G0219

PET imaging whole body; melanoma for noncovered indications

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.16 / $199.16 / $199.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.16 / $1,000.00 / $1,500.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,500.00 / $3,890.01 / $3,890.01
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.00 / $1,405.52 / $4,787.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $50.00 / $65.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,500.00 / $2,500.00 / $2,500.00
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,787.60 / $4,787.60 / $4,787.60