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California rates for HCPCS L5695

Addition to lower extremity, above knee (AK), pelvic control, sleeve suspension, neoprene or equal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.56 / $117.56 / $752.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.15 / $117.56 / $752.99
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.27 / $367.77 / $828.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.06 / $120.12 / $182.03
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $308.99 / $551.76
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $346.27 / $806.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.07 / $122.31 / $139.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.29 / $89.29 / $130.38
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.50 / $113.40 / $287.08
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$156.59 / $182.69 / $404.52
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$397.33 / $1,239.66 / $1,239.66
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,291.84 / $1,291.84 / $1,707.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$535.00 / $535.00 / $535.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.04 / $217.98 / $260.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.29 / $122.31 / $191.31
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.59 / $492.59 / $492.59
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.50 / $160.65 / $208.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.92 / $117.68 / $252.52