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Texas rates for HCPCS L5210

Above knee (AK), short prosthesis, no knee joint (stubbies), with foot blocks, no ankle joints, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,470.68 / $1,470.68 / $1,588.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,386.08 / $1,588.33 / $2,941.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,000.12 / $2,000.12 / $2,000.12
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,359.12 / $3,359.12 / $3,359.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,819.89 / $1,819.89 / $1,819.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,328.52 / $1,328.52 / $1,819.89
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,534.23 / $16,880.98 / $16,880.98
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19,222.38 / $19,222.38 / $29,124.83
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$938.03 / $2,340.96 / $3,359.12
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$948.62 / $3,023.21 / $3,883.31
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$938.03 / $2,244.46 / $3,359.12
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,328.52 / $1,328.52 / $1,940.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,776.27 / $1,776.27 / $1,776.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,210.83 / $1,791.23 / $2,227.94
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,760.19 / $1,762.37 / $3,359.12