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Texas rates for HCPCS L5696

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic joint

Facilitymedian $200 · 10th–90th $115$6170%10%10th90th$200Professionalmedian $126 · 10th–90th $100$2340%20%10th90th$126$0.2$1.0$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $114.82 / $125.89
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $125.89 / $234.42
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $173.78 / $173.78
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $269.15 / $269.15
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $169.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $138.04
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,202.26 / $1,202.26
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,513.56 / $1,819.70 / $1,819.70
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $204.17 / $331.13
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $128.82 / $275.42
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $169.82
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $199.53 / $331.13
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $138.04
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $169.82 / $257.04
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $138.04 / $169.82
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $269.15 / $269.15