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Texas rates for HCPCS L5648

Addition To Lower Extremity Above Knee Air Fluid Gel Or Equal Cushion Socket. (Rvsdf 1/1/04)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.67 / $407.67 / $440.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.07 / $440.28 / $815.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$554.42 / $554.42 / $554.42
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$931.13 / $931.13 / $931.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$589.44 / $589.44 / $589.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.29 / $430.29 / $589.44
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,115.68 / $4,214.43 / $4,214.43
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,246.98 / $5,246.98 / $6,586.50
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.51 / $648.91 / $931.13
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.38 / $790.21 / $931.13
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.51 / $622.16 / $931.13
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.29 / $430.29 / $628.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.53 / $485.99 / $593.98
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.16 / $482.76 / $931.13