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Texas rates for HCPCS L5697

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $41.69 / $44.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $52.48 / $83.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $97.72 / $97.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $60.26
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $616.60 / $616.60
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $724.44 / $724.44
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $85.11 / $131.83
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $54.95 / $125.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.48 / $52.48 / $60.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.66 / $79.43 / $138.04
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $60.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $67.61 / $112.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $58.88 / $74.13
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $97.72 / $97.72