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Texas rates for HCPCS L5677

Additions To Lower Extremity Below Knee Knee Joints Polycentric Pair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$345.46 / $345.46 / $373.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$317.01 / $367.28 / $690.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$469.83 / $469.83 / $469.83
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$789.04 / $789.04 / $789.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.78 / $400.78 / $400.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.57 / $292.57 / $400.78
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,383.28 / $3,128.35 / $3,747.94
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,372.97 / $4,477.91 / $4,477.91
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.60 / $549.89 / $789.04
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.75 / $667.26 / $789.04
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.60 / $527.22 / $789.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.57 / $292.57 / $427.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.03 / $363.96 / $454.95
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.10 / $359.88 / $789.04