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California rates for HCPCS L5620

Addition to lower extremity, test socket, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.42 / $200.42 / $1,012.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.32 / $200.42 / $1,012.86
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.74 / $268.41 / $280.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.19 / $538.16 / $1,114.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.59 / $202.82 / $332.83
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $415.63 / $742.20
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $465.78 / $1,084.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.19 / $209.59 / $209.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.00 / $153.00 / $223.43
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.27 / $129.91 / $386.16
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.63 / $245.74 / $544.13
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$667.37 / $1,729.07 / $1,729.07
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,202.30 / $2,202.30 / $2,960.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,336.06 / $1,336.06 / $1,336.06
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.47 / $310.37 / $368.60
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.00 / $209.59 / $338.87
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.59 / $662.59 / $662.59
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.27 / $184.06 / $280.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.50 / $219.98 / $256.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.69 / $173.57 / $351.61