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California rates for HCPCS L5990

Addition to lower extremity prosthesis, user adjustable heel height

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,175.08 / $1,175.08 / $6,167.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$934.00 / $1,175.08 / $6,167.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$892.33 / $3,243.17 / $6,785.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,068.40 / $1,315.88 / $2,036.77
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $2,530.77 / $4,519.24
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $2,836.32 / $6,606.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$999.82 / $1,222.54 / $1,222.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$892.45 / $892.45 / $2,539.13
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,142.65 / $1,371.18 / $2,351.42
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,282.59 / $1,496.36 / $3,249.24
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,679.32 / $10,198.75 / $10,198.75
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,026.37 / $11,026.37 / $16,032.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,513.62 / $4,513.62 / $4,513.62
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.14 / $1,871.81 / $2,201.77
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$892.45 / $892.45 / $2,087.56
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,034.76 / $4,034.76 / $4,034.76
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,142.65 / $1,710.13 / $1,713.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,217.37 / $2,608.67 / $2,608.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$918.78 / $1,066.46 / $2,156.73