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Washington rates for HCPCS L8417

Prosthetic sheath/sock, including a gel cushion layer, below knee (BK) or above knee (AK), each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.59 / $130.72 / $136.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.88 / $57.59 / $136.49
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.59 / $168.75 / $423.35
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.07 / $77.09 / $456.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.66 / $50.66 / $50.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.97 / $36.97 / $50.66
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.96 / $88.62 / $231.56
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.01 / $89.56 / $171.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.13 / $67.93 / $74.72
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.34 / $86.54 / $91.76
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.76 / $88.62 / $91.76
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.59 / $99.52 / $173.08
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.56 / $73.56 / $87.37
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$84.35 / $86.54 / $86.54
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.39 / $75.33 / $97.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.45 / $60.92 / $77.17
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.75 / $47.75 / $75.33