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Texas rates for HCPCS L5695

Addition To Lower Extremity Above Knee Pelvic Control Sleeve Suspension Neoprene Or Equal Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$114.26 / $114.26 / $123.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.07 / $121.12 / $228.52
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.50 / $155.50 / $155.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,456.92 / $5,821.21 / $8,577.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.20 / $155.38 / $155.38
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.98 / $260.98 / $260.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.31 / $122.31 / $122.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.29 / $89.29 / $122.31
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,037.98 / $1,239.66 / $1,239.66
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,291.84 / $1,291.84 / $1,707.45
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.04 / $181.88 / $260.98
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.76 / $220.70 / $260.98
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.04 / $174.38 / $260.98
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.29 / $89.29 / $130.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.38 / $120.38 / $149.72
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.44 / $120.12 / $260.98