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Tennessee rates for HCPCS L5626

Addition to lower extremity, test socket, hip disarticulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $245.47 / $436.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $316.23 / $478.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $426.58 / $457.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $489.78 / $489.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $489.78
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,090.30 / $3,090.30 / $3,090.30
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,467.37 / $4,265.80 / $4,265.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $380.19 / $436.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $288.40 / $426.58