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Washington rates for HCPCS L5642

Addition to lower extremity, above knee (AK), leather socket

Facilitymedian $1,000 · 10th–90th $575–$1,9500%20%10th90th$1,000Professionalmedian $646 · 10th–90th $331–$1,2590%10%20%10th90th$646$1.0$5.0$20.0$100.0$500.0$2.0K

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
$645.65 / $645.65 / $1,513.56
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $446.68 / $831.76
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$851.14 / $977.24 / $977.24
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $851.14 / $1,122.02
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $524.81 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $524.81
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$467.74 / $1,096.48 / $2,818.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$467.74 / $1,071.52 / $1,737.80
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $758.58 / $831.76
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $977.24 / $1,000.00
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,000.00 / $1,230.27
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $1,445.44 / $1,995.26
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $831.76 / $977.24
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$977.24 / $977.24 / $977.24
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $851.14 / $1,122.02
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $1,000.00 / $1,202.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $501.19 / $707.95
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$398.11 / $851.14 / $1,513.56