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California rates for HCPCS L5681

Addition To Lower Extremity Below Knee/Above Knee Custom Fabricated Socketinsert For Congenital Or Atypical Traumatic Amputee Silicone Gel Elastomericor Equal For Use With Or Without Locking Mechanism Initial Only (For Other Than Initial Use Code L5673 Or L5679)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$852.21 / $852.21 / $4,471.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$677.19 / $852.21 / $4,471.79
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$647.15 / $2,352.07 / $4,919.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$774.66 / $954.08 / $1,476.82
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $1,834.93 / $3,276.65
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $2,056.44 / $4,790.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.69 / $886.63 / $1,231.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$647.24 / $647.24 / $945.19
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$828.47 / $994.16 / $1,704.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$929.94 / $1,084.93 / $2,355.85
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,667.81 / $7,396.37 / $7,396.37
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,010.83 / $8,010.83 / $11,624.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,272.64 / $3,272.64 / $3,272.64
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.00 / $1,370.24 / $1,596.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$647.24 / $886.63 / $1,475.21
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,925.34 / $2,925.34 / $2,925.34
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$828.47 / $1,239.92 / $1,242.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.33 / $773.22 / $1,568.61