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California rates for HCPCS L5987

All Lower Extremity Prosthesis Shank Foot System With Vertical Loading Pylon

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,659.47 / $4,659.47 / $24,455.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,703.46 / $4,659.47 / $24,455.90
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,933.35 / $5,933.35 / $5,933.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,538.30 / $12,859.95 / $26,906.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,236.55 / $5,217.74 / $8,076.50
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $10,035.07 / $17,919.77
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $11,246.50 / $26,196.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,964.50 / $6,042.00 / $6,042.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,410.66 / $4,410.66 / $7,085.17
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,143.06 / $3,771.67 / $9,323.83
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,085.72 / $5,933.35 / $12,883.84
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14,589.81 / $40,507.83 / $40,507.83
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43,722.41 / $43,722.41 / $63,571.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17,897.81 / $17,897.81 / $17,897.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,498.65 / $7,362.64 / $8,730.64
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,410.66 / $6,042.00 / $8,067.79
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15,998.52 / $15,998.52 / $15,998.52
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,143.06 / $5,343.20 / $6,780.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,643.18 / $4,190.97 / $8,201.54