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Texas rates for HCPCS L5642

Addition to lower extremity, above knee (AK), leather socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$335.79 / $335.79 / $362.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.79 / $362.65 / $671.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$456.67 / $456.67 / $456.67
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$766.96 / $766.96 / $766.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.41 / $530.41 / $530.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.20 / $387.20 / $387.20
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,873.08 / $3,966.04 / $3,966.04
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,937.72 / $4,937.72 / $6,655.88
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.50 / $534.49 / $766.96
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.21 / $705.60 / $991.51
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.50 / $530.41 / $766.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$387.20 / $387.20 / $781.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.16 / $457.34 / $567.71
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$449.98 / $454.30 / $766.96