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California rates for HCPCS L5650

Additions to lower extremity, total contact, above knee (AK) or knee disarticulation socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$351.91 / $351.91 / $2,254.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$262.12 / $351.91 / $2,254.11
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.46 / $439.46 / $625.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$267.23 / $1,100.94 / $2,479.92
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$285.83 / $355.30 / $544.91
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $924.92 / $1,651.65
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $1,036.58 / $2,414.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$365.41 / $379.03 / $417.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.69 / $276.69 / $679.13
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.88 / $244.66 / $859.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$468.75 / $546.88 / $1,187.50
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,132.81 / $3,128.86 / $3,710.94
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.63 / $3,890.63 / $5,859.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,409.55 / $1,409.55 / $1,409.55
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$188.72 / $678.61 / $781.25
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.69 / $276.69 / $703.82
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,474.59 / $1,474.59 / $1,474.59
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.88 / $346.60 / $625.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.16 / $313.20 / $709.88