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Tennessee rates for HCPCS L3265

Plastazote sandal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.72 / $6.72 / $7.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.60 / $7.10 / $12.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.65 / $28.65 / $50.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.91 / $20.91 / $28.65
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $90.00 / $90.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.64 / $97.39 / $113.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.78 / $7.77 / $14.01