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Texas rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$301.89 / $301.89 / $326.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.75 / $326.04 / $603.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$410.57 / $410.57 / $410.57
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$689.53 / $689.53 / $689.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$499.82 / $499.82 / $499.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $364.87 / $499.82
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,298.07 / $3,076.44 / $3,076.44
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,592.02 / $3,592.02 / $4,487.55
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.64 / $480.54 / $689.53
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.75 / $620.58 / $725.66
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.64 / $480.54 / $689.53
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $364.87 / $514.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.30 / $382.03 / $445.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.92 / $356.40 / $435.59
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.66 / $352.40 / $689.53