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Washington rates for HCPCS G0428

Collagen meniscus implant procedure for filling meniscal defects (e.g., CMI, collagen scaffold, Menaflex)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$805.20 / $10,122.46 / $27,982.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$805.20 / $805.20 / $805.20
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $111.27 / $1,347.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $50.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79,999.20 / $79,999.20 / $79,999.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$702.00 / $1,323.00 / $5,793.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.22 / $86.22 / $86.22