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Washington rates for HCPCS L5673

Addition to lower extremity, below knee (BK)/above knee (AK), custom fabricated from existing mold or prefabricated, socket insert, silicone gel, elastomeric, or equal, with or without perforations, with or without breathable material, for use with locking mechanism

Facilitymedian $871 · 10th–90th $562–$2,2390%20%10th90th$871Professionalmedian $617 · 10th–90th $380–$1,2880%10%20%10th90th$617$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
$562.34 / $1,318.26 / $2,238.72
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $478.63 / $794.33
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $660.69 / $660.69
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$741.31 / $831.76 / $831.76
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $954.99
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $363.08 / $501.19
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $1,202.26 / $2,398.83
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $1,047.13 / $1,862.09
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $588.84 / $724.44
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$676.08 / $831.76 / $851.14
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $851.14 / $851.14
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $1,258.93 / $1,737.80
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $831.76
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $831.76 / $831.76
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $954.99
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $1,318.26 / $1,318.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $537.03 / $758.58
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $741.31 / $1,318.26