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Washington rates for HCPCS L5200

Above knee (AK), molded socket, single axis constant friction knee, shin, SACH foot

Facilitymedian $4,898 · 10th–90th $3,090–$10,4710%20%10th90th$4,898Professionalmedian $3,162 · 10th–90th $1,950–$6,4570%20%10th90th$3,162$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,162.28 / $7,585.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,398.83 / $4,073.80
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,265.80 / $4,786.30 / $4,786.30
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,265.80 / $4,265.80 / $5,495.41
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,754.23 / $2,754.23 / $2,754.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $1,995.26 / $2,754.23
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,511.89 / $5,888.44 / $13,803.84
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,511.89 / $5,623.41 / $9,120.11
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $3,715.35 / $4,168.69
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,890.45 / $4,786.30 / $4,897.79
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,981.07 / $4,365.16 / $4,897.79
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,265.80 / $7,244.36 / $9,772.37
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,073.80 / $4,073.80 / $4,786.30
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,786.30 / $4,786.30 / $4,786.30
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,265.80 / $4,265.80 / $5,495.41
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,630.27 / $5,370.32 / $6,456.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $2,630.27 / $3,801.89
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $4,265.80 / $7,413.10