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California rates for HCPCS L5968

Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,353.73 / $2,353.73 / $12,354.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,870.82 / $2,353.73 / $12,354.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,425.42 / $3,425.42 / $3,425.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,787.37 / $6,496.20 / $13,591.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,197.85 / $2,635.75 / $4,079.80
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $5,069.22 / $9,052.20
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $5,681.19 / $13,233.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,002.67 / $2,448.80 / $2,448.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,787.62 / $1,787.62 / $2,871.59
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,623.84 / $1,948.61 / $4,709.95
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,569.06 / $2,997.24 / $6,508.29
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,369.96 / $20,504.11 / $20,504.11
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22,086.40 / $22,086.40 / $32,113.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,243.69 / $13,243.69 / $13,243.69
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,262.19 / $3,719.25 / $4,410.26
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,787.62 / $2,448.80 / $4,075.46
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,081.69 / $8,081.69 / $8,081.69
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,623.84 / $2,760.53 / $3,425.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,860.49 / $2,136.13 / $4,281.77