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Washington rates for HCPCS L5975

All lower extremity prostheses, combination single axis ankle and flexible keel foot

Facilitymedian $550 · 10th–90th $355–$1,3180%20%10th90th$550Professionalmedian $389 · 10th–90th $245–$7940%20%10th90th$389$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
$354.81 / $354.81 / $831.76
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $302.00 / $489.78
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$478.63 / $537.03 / $537.03
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $478.63 / $616.60
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $363.08 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $263.03 / $363.08
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $707.95 / $1,548.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $645.65 / $1,148.15
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $416.87 / $457.09
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $537.03 / $549.54
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $549.54
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$478.63 / $794.33 / $1,096.48
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$457.09 / $457.09 / $537.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $537.03 / $537.03
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $478.63 / $616.60
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $331.13 / $478.63
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $478.63 / $831.76