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Washington rates for HCPCS L5642

Addition To Lower Extremity Above Knee Leather Socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.33 / $1,462.63 / $1,527.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$495.76 / $644.33 / $1,527.06
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$868.20 / $1,791.30 / $3,873.08
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$544.54 / $842.78 / $4,937.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.41 / $530.41 / $530.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.20 / $387.20 / $530.41
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $941.93 / $2,130.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.25 / $941.93 / $1,578.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$684.08 / $760.09 / $836.09
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$787.04 / $968.27 / $991.51
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$892.36 / $991.51 / $991.51
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$868.20 / $1,113.51 / $1,936.54
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$943.73 / $968.27 / $968.27
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$787.66 / $842.78 / $1,090.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$370.99 / $558.84 / $707.80
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.63 / $398.63 / $454.30