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California rates for HCPCS L5643

Addition To Lower Extremity Hip Disarticulation Flexible Inner Socket External Frame

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,121.99 / $1,121.99 / $5,389.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$835.70 / $1,121.99 / $5,389.95
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$852.02 / $2,863.80 / $5,929.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,131.33 / $1,131.33 / $2,249.07
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $2,211.67 / $3,949.41
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $2,478.66 / $5,773.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$873.75 / $1,167.30 / $1,167.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$852.13 / $852.13 / $1,244.40
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$690.03 / $828.04 / $2,054.91
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,120.85 / $1,307.67 / $2,839.51
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,909.27 / $9,963.20 / $9,963.20
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,404.18 / $12,404.18 / $14,010.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,118.88 / $4,118.88 / $4,118.88
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$601.66 / $1,681.29 / $1,961.51
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$852.13 / $1,167.30 / $1,956.72
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,525.99 / $3,525.99 / $3,525.99
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$690.03 / $1,173.05 / $1,494.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$877.27 / $948.32 / $1,904.66