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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
$1,122.02 / $1,122.02 / $8,128.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,174.90 / $7,079.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $1,071.52 / $4,466.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $2,511.89
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $3,235.94 / $4,365.16
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $3,548.13 / $6,025.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,174.90 / $1,174.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $1,174.90
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $870.96 / $2,290.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,698.24 / $3,019.95
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,302.69 / $14,125.38 / $14,125.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $1,862.09 / $2,511.89
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $851.14 / $2,041.74
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $3,548.13
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,023.29 / $1,698.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $1,230.27 / $2,511.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,122.02 / $1,905.46