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California rates for HCPCS 95875

Ischemic Limb Xers Tst Spec Acquisj Metab

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.60 / $129.66 / $188.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.14 / $122.26 / $229.63
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.40 / $108.86 / $263.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.82 / $158.62 / $372.46
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.18 / $64.91 / $205.05
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.38 / $148.66 / $258.62
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.77 / $880.77 / $997.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $168.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.30 / $186.73 / $367.49
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.56 / $445.56 / $445.56
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.91 / $122.83 / $168.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.55 / $136.08 / $339.07