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Washington rates for HCPCS L5656

Addition To Lower Extremity Socket Insert Knee Disarticulation (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$385.77 / $875.70 / $914.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.72 / $385.77 / $914.28
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$519.80 / $1,072.48 / $2,344.02
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.98 / $504.59 / $2,938.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.84 / $335.84 / $335.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.16 / $245.16 / $335.84
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$280.27 / $563.96 / $1,275.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.58 / $563.96 / $944.17
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$409.57 / $455.08 / $500.58
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$448.67 / $511.08 / $593.64
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.44 / $534.28 / $593.64
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$519.80 / $666.68 / $1,159.44
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$565.03 / $579.72 / $579.72
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.59 / $504.59 / $653.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.12 / $333.18 / $423.77
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.18 / $234.18 / $270.76