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Washington rates for HCPCS Q9991

Injection, buprenorphine extended-release (Sublocade), less than or equal to 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,218.07 / $3,253.14 / $4,111.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,996.32 / $2,218.07 / $2,391.63
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,887.11 / $2,942.34 / $5,688.52
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,016.42 / $2,041.16 / $2,540.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,902.29 / $1,902.29 / $4,684.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,016.42 / $2,016.42 / $2,472.96
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,961.56 / $2,016.42 / $4,102.28
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.40 / $3,019.38 / $5,283.92
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,895.36 / $2,095.83 / $2,419.82
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,886.37 / $2,353.87 / $4,367.41
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,016.42 / $2,016.42 / $2,016.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,925.23 / $2,016.42 / $2,016.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,016.42 / $2,016.42 / $2,016.42