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Washington rates for HCPCS L1902

Ankle Orthosis Ankle Gauntlet Or Similiar With Or Without Joints Prefabricated Off-The-Shelf (Revised 01/01/2016)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.41 / $168.91 / $176.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.00 / $66.15 / $231.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.73 / $110.27 / $121.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.56 / $210.00 / $472.21
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.41 / $93.73 / $593.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.94 / $58.00 / $58.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.34 / $42.34 / $58.00
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.42 / $107.69 / $257.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.48 / $105.65 / $190.32
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.52 / $103.92 / $117.05
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.54 / $98.92 / $110.27
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.93 / $110.27 / $110.27
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.56 / $123.84 / $215.38
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.54 / $91.54 / $91.54
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.96 / $107.69 / $107.69
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.60 / $93.73 / $121.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.48 / $44.94 / $85.60
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.16 / $42.16 / $54.74