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California rates for HCPCS L5668

Addition to lower extremity, below knee (BK), molded distal cushion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.44 / $72.44 / $707.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $72.44 / $616.60
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $120.23 / $123.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $70.79 / $316.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $83.18 / $177.83
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $281.84 / $380.19
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $302.00 / $524.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $89.13 / $89.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $89.13
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $74.13 / $199.53
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $147.91 / $269.15
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $776.25
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $954.99 / $954.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $234.42 / $234.42
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $141.25 / $199.53
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $131.83
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $302.00 / $302.00
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $89.13 / $147.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10.00 / $79.43 / $165.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $72.44 / $162.18