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California rates for HCPCS L4210

Repair of orthotic device, repair or replace minor parts

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.38 / $19.95 / $19.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $19.95 / $138.04
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $199.53 / $199.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $56.23 / $141.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $57.54 / $60.26
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $91.20 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $117.49 / $117.49
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $79.43 / $630.96
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $77.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $199.53 / $199.53
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.95 / $19.95 / $33.88
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $31.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.02 / $51.29 / $51.29