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Washington rates for HCPCS G2069

Medication assisted treatment, buprenorphine (injectable) administered on a monthly basis; bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing if performed (provision of the services by a Medicare-enrolled opioid treatment program)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,825.83 / $1,825.83 / $1,825.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,773.55 / $1,825.83 / $2,117.23
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.08 / $1,757.11 / $1,994.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,373.25 / $2,373.25 / $2,984.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.00 / $75.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,026.62 / $79,999.20 / $79,999.20
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,757.29 / $2,034.82 / $2,034.82