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California rates for HCPCS L5647

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$573.41 / $573.41 / $3,672.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.01 / $573.41 / $3,672.89
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.10 / $891.10 / $1,018.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$435.44 / $1,793.91 / $4,040.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.75 / $581.25 / $887.92
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $1,507.11 / $2,691.26
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $1,689.05 / $3,934.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$595.41 / $596.58 / $680.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.50 / $435.50 / $1,107.00
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$539.64 / $647.57 / $1,400.30
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$763.80 / $891.10 / $1,934.96
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,938.14 / $5,050.38 / $6,046.75
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,402.83 / $6,556.50 / $7,495.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,867.04 / $2,867.04 / $2,867.04
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.50 / $1,049.32 / $1,273.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.50 / $435.50 / $1,082.05
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,402.71 / $2,402.71 / $2,402.71
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$539.64 / $917.39 / $1,018.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.68 / $629.41 / $733.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$448.35 / $559.41 / $1,273.00