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Washington rates for HCPCS L5696

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic joint

Facilitymedian $295 · 10th–90th $174–$5890%20%10th90th$295Professionalmedian $191 · 10th–90th $105–$3720%10%20%10th90th$191$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
$190.55 / $190.55 / $457.09
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $131.83 / $245.47
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $288.40 / $288.40
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $257.04 / $331.13
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $138.04
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $331.13 / $831.76
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $323.59 / $512.86
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $229.09 / $251.19
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $288.40 / $295.12
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $295.12 / $323.59
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $436.52 / $588.84
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $245.47 / $288.40
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $288.40
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $257.04 / $331.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $302.00 / $363.08
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $147.91 / $213.80
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $257.04 / $457.09