go back

Tennessee rates for HCPCS L5624

Addition to lower extremity, test socket, above knee (AK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.41 / $189.04 / $189.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.41 / $207.67 / $324.77
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.27 / $327.27 / $327.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.99 / $392.72 / $392.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$233.25 / $311.77 / $311.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.60 / $227.60 / $311.77
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$756.24 / $2,310.33 / $2,370.48
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,879.96 / $2,879.96 / $3,781.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.13 / $217.69 / $328.00