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Texas rates for HCPCS L5646

Addition to lower extremity, below knee (BK), air, fluid, gel or equal, cushion socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$371.54 / $371.54 / $407.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $398.11 / $707.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $407.38 / $512.86
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $870.96 / $870.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $407.38 / $407.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $302.00 / $407.38
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $3,467.37 / $3,467.37
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,265.80 / $5,248.07 / $5,248.07
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $645.65 / $954.99
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $398.11 / $741.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $537.03
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $645.65 / $977.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $302.00 / $407.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $457.09 / $758.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $407.38 / $501.19
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $870.96 / $870.96