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California rates for HCPCS L5971

All lower extremity prostheses, solid ankle cushion heel (SACH) foot, replacement only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.40 / $146.40 / $884.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.04 / $146.40 / $884.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.17 / $433.99 / $973.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.38 / $148.22 / $243.87
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $363.06 / $648.30
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $406.89 / $947.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.21 / $159.21 / $271.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.22 / $116.22 / $169.72
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.92 / $196.70 / $337.34
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.00 / $214.67 / $475.34
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$532.33 / $1,456.68 / $1,456.68
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,472.02 / $1,472.02 / $1,828.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$560.01 / $560.01 / $560.01
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.51 / $273.18 / $310.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.22 / $159.21 / $280.22
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$578.82 / $578.82 / $578.82
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.92 / $245.34 / $245.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.47 / $144.01 / $298.47