go back

Texas rates for HCPCS L5654

Addition To Lower Extremity Socket Insert Symes (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$207.16 / $207.16 / $504.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.58 / $223.73 / $414.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.73 / $281.73 / $281.73
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$473.15 / $473.15 / $473.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$306.16 / $306.16 / $306.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $223.50 / $306.16
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.06 / $2,322.98 / $2,322.98
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,347.44 / $2,347.44 / $3,161.55
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.19 / $329.74 / $473.15
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.65 / $425.84 / $473.15
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.19 / $316.14 / $473.15
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $223.50 / $326.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.49 / $244.81 / $299.20
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.07 / $240.86 / $473.15