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Washington rates for HCPCS V2790

Amniotic membrane for surgical reconstruction, per procedure

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$404.12 / $404.13 / $509.11
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $725.00 / $725.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $725.00 / $1,550.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.51 / $104.51 / $104.51
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $50.00 / $75.00
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$725.00 / $725.00 / $725.00
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$725.00 / $725.00 / $1,000.00