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Texas rates for HCPCS L5668

Addition to lower extremity, below knee (BK), molded distal cushion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $70.79 / $75.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $72.44 / $131.83
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $114.82 / $138.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,548.13 / $4,265.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $104.71
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$128.82 / $128.82 / $128.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $89.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $89.13
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $776.25
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $954.99 / $954.99
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $120.23 / $190.55
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $75.86 / $141.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $91.20 / $93.33
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $120.23 / $199.53
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $89.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $85.11 / $141.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $75.86 / $93.33
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $165.96 / $165.96