go back

Texas rates for HCPCS L5975

All lower extremity prostheses, combination single axis ankle and flexible keel foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.35 / $246.35 / $266.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.35 / $266.06 / $492.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.77 / $335.04 / $335.04
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.66 / $562.66 / $562.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.03 / $362.03 / $362.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $264.27 / $362.03
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$940.25 / $2,615.79 / $2,615.79
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,817.63 / $2,817.63 / $4,096.72
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.02 / $392.12 / $562.66
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.84 / $506.40 / $562.66
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.02 / $375.95 / $562.66
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $264.27 / $385.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.86 / $307.49 / $375.95
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.54 / $305.45 / $562.66