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California rates for HCPCS L5828

Addition, endoskeletal knee-shin system, single axis, fluid swing and stance phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,035.69 / $2,035.69 / $12,667.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,483.94 / $2,035.69 / $12,667.80
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,512.43 / $3,512.43 / $3,512.43
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,545.86 / $6,187.15 / $13,936.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,735.00 / $2,063.67 / $3,308.33
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $5,198.01 / $9,282.16
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $5,825.51 / $13,569.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,053.55 / $2,117.90 / $2,346.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,546.07 / $1,546.07 / $4,123.88
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,687.63 / $2,025.16 / $4,829.59
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,634.32 / $3,073.38 / $6,673.62
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,221.40 / $20,855.07 / $20,855.07
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21,074.59 / $21,074.59 / $31,063.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,948.29 / $6,948.29 / $6,948.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,091.64 / $3,557.34 / $4,390.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,546.07 / $1,546.07 / $3,731.96
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,286.99 / $8,286.99 / $8,286.99
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,687.63 / $2,868.97 / $3,512.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,591.67 / $1,720.58 / $4,166.85