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Washington rates for HCPCS L5658

Addition to lower extremity, socket insert, above knee (AK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Facilitymedian $575 · 10th–90th $339–$1,1480%20%10th90th$575Professionalmedian $380 · 10th–90th $204–$7240%10%10th90th$380$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
$380.19 / $380.19 / $891.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $263.03 / $489.78
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $562.34 / $562.34
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $645.65
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $363.08 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $269.15 / $363.08
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $645.65 / $1,621.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $630.96 / $1,000.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $446.68 / $489.78
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$457.09 / $562.34 / $575.44
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $575.44 / $575.44
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $851.14 / $1,174.90
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $478.63 / $562.34
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $562.34 / $562.34
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $645.65
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $588.84 / $707.95
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $288.40 / $416.87
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $501.19 / $891.25