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California rates for HCPCS L5671

Addition to lower extremity, below knee (BK)/above knee (AK) suspension locking mechanism (shuttle, lanyard, or equal), excludes socket insert

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$358.57 / $358.57 / $2,296.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.85 / $358.57 / $2,296.71
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$557.22 / $557.22 / $636.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$272.33 / $1,121.77 / $2,526.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.00 / $412.43 / $573.86
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $942.40 / $1,682.86
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $1,056.19 / $2,460.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$372.31 / $380.63 / $425.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.86 / $277.86 / $405.78
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.50 / $510.60 / $875.63
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.62 / $557.22 / $1,209.97
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,218.09 / $3,301.32 / $3,781.14
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,654.76 / $4,766.49 / $4,766.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,072.28 / $2,072.28 / $2,072.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.28 / $690.08 / $796.03
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.86 / $380.63 / $757.67
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,502.46 / $1,502.46 / $1,502.46
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.50 / $636.82 / $638.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$280.36 / $344.32 / $735.28