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California rates for HCPCS L5637

Addition to lower extremity, below knee (BK), total contact

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.25 / $208.25 / $1,328.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.43 / $208.25 / $1,328.66
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.36 / $368.41 / $368.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.13 / $648.95 / $1,461.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$210.73 / $210.85 / $429.95
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $545.17 / $973.53
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $611.02 / $1,423.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$215.38 / $232.98 / $246.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.08 / $170.08 / $273.20
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.15 / $295.38 / $506.56
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.31 / $322.36 / $699.98
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$938.49 / $2,187.42 / $2,187.42
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,288.42 / $2,288.42 / $3,317.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,388.30 / $1,388.30 / $1,388.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.68 / $391.43 / $462.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.08 / $232.98 / $348.95
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$869.18 / $869.18 / $869.18
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.15 / $368.41 / $369.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.76 / $208.46 / $616.12