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California rates for HCPCS L5100

Below knee (BK), molded socket, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $1,659.59 / $14,125.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,659.59 / $12,302.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,621.81 / $6,918.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,698.24 / $3,548.13
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $5,623.41 / $7,585.78
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $6,025.60 / $10,471.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $1,737.80 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $1,737.80
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,288.25 / $3,981.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $2,951.21 / $5,248.07
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,488.17 / $15,488.17 / $15,488.17
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16,982.44 / $22,908.68 / $22,908.68
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,388.44 / $3,388.44 / $3,388.44
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $2,884.03 / $4,073.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,258.93 / $3,162.28
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,025.60 / $6,025.60 / $6,025.60
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,548.82 / $2,951.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $1,819.70 / $3,801.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,659.59 / $3,235.94