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Washington rates for HCPCS L5301

Below knee (BK), molded socket, shin, SACH foot, endoskeletal system

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,185.17 / $4,161.00 / $5,178.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,389.25 / $2,185.17 / $5,178.85
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,521.92 / $2,521.92 / $2,577.78
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,944.38 / $6,403.31 / $14,785.52
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,350.21 / $2,891.80 / $17,561.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,721.98 / $1,721.98 / $1,721.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,257.05 / $1,257.05 / $1,721.98
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,734.00 / $3,307.13 / $7,890.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,735.91 / $3,221.73 / $5,847.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,320.00 / $2,577.78 / $2,835.55
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,669.13 / $3,026.30 / $3,362.56
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,778.50 / $3,362.56 / $3,698.82
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,944.38 / $3,776.31 / $6,567.50
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,200.54 / $3,283.75 / $3,283.75
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,671.27 / $2,858.18 / $3,698.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,674.38 / $4,409.26 / $4,409.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,374.83 / $2,068.92 / $2,623.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,563.41 / $1,563.41 / $1,972.92