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Washington rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Facilitymedian $155 · 10th–90th $98$3630%20%10th90th$155Professionalmedian $107 · 10th–90th $68$2190%10%20%10th90th$107$1.0$5.0$20.0$100.0$500.0

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
$97.72 / $97.72 / $234.42
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $81.28 / $134.90
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $114.82 / $114.82
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $147.91 / $147.91
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $169.82
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $100.00
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $204.17 / $426.58
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $177.83 / $316.23
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $114.82 / $125.89
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $147.91 / $151.36
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $154.88 / $165.96
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $218.78 / $302.00
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $147.91
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $147.91 / $147.91
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $169.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $223.87 / $223.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $93.33 / $131.83
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $131.83 / $229.09