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Texas rates for HCPCS L5976

All lower extremity prostheses, energy storing foot (Seattle Carbon Copy II or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.98 / $318.98 / $344.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.98 / $344.50 / $637.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.81 / $433.81 / $433.81
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$728.57 / $728.57 / $728.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$420.01 / $420.01 / $420.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.61 / $306.61 / $420.01
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,532.12 / $3,565.60 / $4,257.09
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,843.43 / $4,959.68 / $6,361.13
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.49 / $511.15 / $728.57
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.93 / $655.71 / $751.39
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.49 / $486.81 / $728.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$306.61 / $306.61 / $447.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.45 / $413.39 / $505.25
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$406.73 / $409.90 / $728.57