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Texas rates for HCPCS L5658

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.07 / $191.07 / $206.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.07 / $206.35 / $382.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.69 / $259.85 / $259.85
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.40 / $436.40 / $436.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$366.26 / $366.26 / $366.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $267.37 / $366.26
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$920.61 / $2,323.85 / $2,323.85
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,880.26 / $2,880.26 / $3,523.65
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.55 / $312.33 / $436.40
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.13 / $401.49 / $581.87
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.55 / $312.33 / $436.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $267.37 / $390.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.43 / $268.39 / $333.17
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.07 / $266.11 / $436.40