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California rates for HCPCS L6965

Shoulder Disarticulation External Power Molded Inner Socket Removable Shoulder Shell Shoulder Bulkhead Humeral Section Mechanical Elbow Forearm Otto Bock Or Equal Electrodes Cables Two Batteries And One Charger Myoelectronic Control Of Terminal Device

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,216.62 / $10,216.62 / $51,380.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,747.50 / $10,216.62 / $51,380.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,758.26 / $27,299.68 / $56,527.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,089.95 / $10,344.35 / $16,873.46
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $21,083.08 / $37,648.35
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $23,628.20 / $55,038.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,329.17 / $11,736.82 / $11,736.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,567.87 / $8,567.87 / $12,512.04
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,667.50 / $8,001.00 / $19,588.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,684.81 / $12,465.61 / $27,068.18
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32,206.69 / $87,176.00 / $87,176.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112,269.81 / $112,269.81 / $127,579.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46,495.57 / $46,495.57 / $46,495.57
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,478.66 / $15,468.45 / $18,698.41
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8,567.87 / $11,736.82 / $16,781.45
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33,611.94 / $33,611.94 / $33,611.94
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,667.50 / $11,334.75 / $14,246.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,988.22 / $8,884.21 / $20,865.03