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Washington rates for HCPCS L4392

Replacement, soft interface material, static AFO

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.20 / $18.20 / $43.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $15.14 / $25.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $15.85 / $15.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.48 / $11.48 / $15.85
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.85 / $38.02 / $77.62
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $33.11 / $58.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $27.54 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.38 / $26.30 / $28.18
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.55 / $26.92 / $28.18
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.99 / $39.81 / $58.88
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.39 / $22.39 / $26.92
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.30 / $26.30 / $26.30
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.39 / $23.44 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.59 / $41.69 / $41.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11.75 / $13.49 / $23.99
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $23.44 / $41.69