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Washington rates for HCPCS L5968

Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,782.53 / $6,316.34 / $6,594.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,217.51 / $2,782.53 / $6,594.60
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,211.33 / $3,211.33 / $3,282.44
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,749.27 / $8,153.77 / $20,504.11
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,049.13 / $3,747.06 / $22,086.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,448.80 / $2,448.80 / $2,448.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,787.62 / $1,787.62 / $2,448.80
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,465.64 / $4,281.77 / $11,220.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,468.35 / $4,333.57 / $8,315.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,954.19 / $3,282.44 / $3,610.68
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,398.78 / $4,181.42 / $4,435.02
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,853.59 / $4,281.77 / $4,435.02
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,749.27 / $4,808.63 / $8,362.84
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,075.46 / $4,181.42 / $4,181.42
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,401.49 / $3,639.50 / $4,709.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,955.12 / $2,860.96 / $3,730.12
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,365.44 / $2,365.44 / $2,635.75