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Washington rates for HCPCS L5681

Addition to lower extremity, below knee (BK)/above knee (AK), custom fabricated socket insert for congenital or atypical traumatic amputee, silicone gel, elastomeric or equal, for use with or without locking mechanism, initial only (for other than initial, use code L5673 or L5679)

Facilitymedian $1,549 · 10th–90th $1,000–$3,5480%20%10th90th$1,549Professionalmedian $1,096 · 10th–90th $676–$2,2910%20%10th90th$1,096$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$1,000.00 / $1,000.00 / $2,398.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $851.14 / $1,412.54
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,174.90 / $1,174.90
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,513.56 / $1,513.56
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,737.80
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$891.25 / $891.25 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $645.65 / $891.25
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$891.25 / $1,995.26 / $4,365.16
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $1,862.09 / $3,311.31
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $1,071.52 / $1,318.26
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,513.56 / $1,548.82
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,548.82 / $1,621.81
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $2,290.87 / $3,090.30
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,288.25 / $1,513.56
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,513.56 / $1,513.56 / $1,513.56
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,737.80
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $2,290.87 / $2,290.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $954.99 / $1,348.96
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $1,348.96 / $2,344.23