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California rates for HCPCS L5301

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,655.14 / $1,655.14 / $10,556.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,286.42 / $1,655.14 / $10,556.20
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,561.07 / $2,926.94 / $2,926.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,256.86 / $5,155.80 / $11,613.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,577.81 / $1,972.92 / $3,007.92
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $4,331.56 / $7,734.92
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $4,854.43 / $11,307.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,711.25 / $1,721.98 / $1,955.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,257.05 / $1,257.05 / $2,019.28
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,955.71 / $2,346.85 / $4,024.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,195.19 / $2,561.07 / $5,561.18
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,499.00 / $14,785.52 / $17,378.68
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,561.62 / $17,575.11 / $20,668.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,940.18 / $9,940.18 / $9,940.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$887.57 / $3,178.03 / $3,658.67
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,257.05 / $1,721.98 / $3,200.54
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,905.61 / $6,905.61 / $6,905.61
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,955.71 / $2,926.94 / $2,933.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,123.22 / $3,674.38 / $3,674.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,308.29 / $1,656.80 / $3,814.09