go back

Washington rates for HCPCS L3649

Orthopedic Shoe Modification Addition Or Transfer Not Otherwise Specified (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $11.00 / $11.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.40 / $100.00 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $8.00 / $75.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.12 / $0.12 / $0.12
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.80 / $0.80 / $1.20
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $0.80 / $1.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $50.00 / $85.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,105.71 / $1,105.71 / $1,105.71
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,105.71 / $1,105.71 / $1,105.71