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Washington rates for HCPCS L4210

Repair Of Orthotic Device Repair Or Replace Minor Parts (Special Coverage Instructions Apply. See Mcm: 2133 2100.4 2130d)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.00 / $59.81 / $235.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.00 / $20.00 / $33.46
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $90.00 / $100.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.64 / $55.80 / $75.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.89 / $117.89 / $117.89
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
$45.00 / $55.00 / $85.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.20 / $239.20 / $239.20
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.20 / $239.20 / $239.20
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.80 / $55.80 / $55.80