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California rates for HCPCS L5701

Replacement Socket Above Knee/Knee Disarticulation Including Attachment Plate Molded To Patient Model

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,451.05 / $2,451.05 / $15,699.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,807.98 / $2,451.05 / $15,699.50
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,445.37 / $3,445.37 / $3,445.37
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,861.27 / $7,667.88 / $17,272.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,241.00 / $2,469.21 / $4,272.25
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $6,442.02 / $11,503.61
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $7,219.69 / $16,817.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,545.00 / $2,550.04 / $2,908.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,861.53 / $1,861.53 / $2,990.32
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,017.64 / $2,421.17 / $5,985.43
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,264.78 / $3,808.91 / $8,270.78
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,325.45 / $25,846.18 / $25,846.18
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26,362.41 / $26,362.41 / $31,152.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,465.51 / $8,465.51 / $8,465.51
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,314.38 / $4,544.64 / $5,441.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,861.53 / $2,550.04 / $5,069.12
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,270.27 / $10,270.27 / $10,270.27
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,017.64 / $3,429.99 / $4,353.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,625.10 / $5,441.30 / $5,441.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,916.44 / $2,391.19 / $5,169.07