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Washington rates for HCPCS Q9992

Injection, buprenorphine extended-release (Sublocade), greater than 100 mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,981.07 / $5,754.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,041.74 / $2,511.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $1,905.46 / $3,890.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $2,454.71
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $1,995.26 / $3,019.95
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $2,238.72 / $5,248.07
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,089.30 / $2,290.87
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $2,344.23 / $5,623.41
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $2,570.40