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California rates for HCPCS L5250

Hip disarticulation, Canadian type; molded socket, hip joint, single axis constant friction knee, shin, SACH foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,740.27 / $3,740.27 / $23,957.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,921.84 / $3,740.27 / $23,957.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,840.27 / $11,701.08 / $26,357.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,381.69 / $3,804.46 / $6,277.32
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $9,830.42 / $17,554.32
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $11,017.14 / $25,662.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,883.65 / $4,366.38 / $4,438.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,187.46 / $3,187.46 / $4,497.37
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,083.60 / $2,500.32 / $9,133.69
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,982.01 / $5,812.35 / $12,621.09
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,702.11 / $33,390.44 / $39,440.91
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45,658.26 / $46,754.06 / $49,888.58
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,881.94 / $13,881.94 / $13,881.94
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,005.72 / $6,935.09 / $8,424.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,187.46 / $4,366.38 / $7,312.14
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,672.28 / $15,672.28 / $15,672.28
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,083.60 / $3,542.12 / $6,642.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,924.46 / $3,744.01 / $8,081.24