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California rates for HCPCS L5781

Addition To Lower Limb Prosthesis Vacuum Pump Residual Limb Volume Management And Moisture Evacuation System

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,591.62 / $2,591.62 / $13,602.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,059.88 / $2,591.62 / $13,602.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,968.01 / $7,152.73 / $14,965.17
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,420.00 / $2,902.12 / $4,492.17
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $5,581.51 / $9,966.99
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $6,255.31 / $14,570.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,205.06 / $2,886.72 / $2,886.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,107.31 / $2,107.31 / $3,077.39
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,520.06 / $3,024.07 / $5,185.93
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,828.69 / $3,300.14 / $7,166.01
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,114.89 / $22,493.11 / $22,493.11
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24,318.59 / $24,318.59 / $35,358.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,389.75 / $4,128.16 / $4,856.02
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,107.31 / $2,886.72 / $4,487.31
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,898.40 / $8,898.40 / $8,898.40
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,520.06 / $3,771.58 / $3,780.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,890.35 / $5,753.36 / $5,753.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,006.28 / $2,352.00 / $4,771.42