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Washington rates for HCPCS L5683

Addition To Lower Extremity Below Knee/Above Knee Custom Fabricated Socket Insert For Other Than Congenital Or Atypical Traumatic Amputee Siliconegel Elastomeric Or Equal For Use With Or Without Locking Mechanism Initial Only(For Other Than I Nitial Use Code L5673 Or L5679)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,007.20 / $2,286.34 / $2,387.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$804.30 / $1,007.20 / $2,387.06
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,357.14 / $2,951.46 / $7,396.37
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,103.99 / $1,356.35 / $8,010.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$950.52 / $950.52 / $950.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$693.88 / $693.88 / $950.52
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$892.71 / $1,549.90 / $4,062.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$893.69 / $1,569.01 / $3,011.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,069.34 / $1,188.16 / $1,306.97
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.26 / $1,513.57 / $1,608.60
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,394.91 / $1,549.90 / $1,608.60
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,357.14 / $1,740.61 / $3,027.14
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,475.21 / $1,513.57 / $1,513.57
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,231.25 / $1,317.42 / $1,704.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.89 / $1,015.55 / $1,350.55
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.08 / $954.08 / $954.08