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California rates for HCPCS L5640

Addition to lower extremity, knee disarticulation, leather socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$460.95 / $460.95 / $2,686.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.02 / $460.95 / $2,686.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$350.04 / $1,344.17 / $2,956.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$443.16 / $468.88 / $822.60
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $1,102.50 / $1,968.75
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $1,235.59 / $2,878.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$435.55 / $572.20 / $572.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.71 / $417.71 / $589.37
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.47 / $161.38 / $1,024.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$558.75 / $651.88 / $1,415.50
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,795.58 / $4,423.43 / $4,423.43
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,096.03 / $5,096.03 / $7,674.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,573.31 / $1,573.31 / $1,573.31
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$247.19 / $804.80 / $943.83
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.71 / $572.20 / $931.25
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,757.68 / $1,757.68 / $1,757.68
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.47 / $228.62 / $745.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.41 / $460.44 / $981.75