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Washington rates for HCPCS L5962

Addition Endoskeletal System Below Knee Flexible Protective Outer Surface Covering System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$611.29 / $1,387.63 / $1,448.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$449.37 / $611.29 / $1,448.76
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$823.67 / $1,699.41 / $3,726.17
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$555.66 / $818.37 / $4,656.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$448.56 / $448.56 / $448.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.45 / $327.45 / $448.56
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.08 / $893.62 / $2,019.37
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.56 / $893.62 / $1,497.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$649.00 / $721.12 / $793.23
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$746.68 / $898.74 / $940.65
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$846.59 / $940.65 / $940.65
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$823.67 / $1,056.39 / $1,837.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$895.33 / $918.60 / $918.60
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$747.27 / $799.55 / $1,034.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$470.15 / $470.15 / $470.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.96 / $530.17 / $671.50
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$404.33 / $404.33 / $455.05