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Washington rates for HCPCS L5701

Replacement, socket, above knee (AK)/knee disarticulation, including attachment plate, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,460.95 / $7,856.36 / $8,202.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,272.91 / $3,460.95 / $8,202.45
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,663.39 / $9,621.70 / $21,140.73
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,144.90 / $4,526.88 / $26,362.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,550.04 / $2,550.04 / $2,550.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,861.53 / $1,861.53 / $2,550.04
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,567.56 / $5,059.45 / $11,684.06
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,570.38 / $5,059.45 / $8,659.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,674.46 / $4,082.74 / $4,491.01
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,227.45 / $4,793.17 / $5,325.74
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,545.81 / $5,325.74 / $5,325.74
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,663.39 / $5,981.06 / $10,401.84
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,069.12 / $5,200.92 / $5,200.92
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,230.82 / $4,526.88 / $5,858.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,441.30 / $6,529.56 / $6,529.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,035.96 / $3,066.88 / $3,884.34
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,192.92 / $2,192.92 / $2,469.21