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Washington rates for HCPCS L5972

All lower extremity prostheses, foot, flexible keel

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$305.77 / $694.10 / $724.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.20 / $305.77 / $724.68
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.88 / $352.88 / $352.88
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$412.00 / $935.48 / $2,270.36
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.94 / $431.87 / $2,957.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$293.77 / $293.77 / $293.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.45 / $214.45 / $293.77
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$266.17 / $470.51 / $1,210.31
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.45 / $470.51 / $897.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$324.63 / $360.71 / $396.78
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$373.50 / $459.48 / $528.40
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.46 / $470.51 / $528.40
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$412.00 / $528.40 / $918.96
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$447.84 / $459.48 / $459.48
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.79 / $399.93 / $517.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.00 / $676.80 / $676.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.03 / $316.55 / $402.62
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.95 / $189.95 / $272.08