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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
$243.15 / $247.92 / $247.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$243.15 / $249.03 / $425.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.96 / $515.03 / $515.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$305.89 / $493.58 / $493.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.31 / $360.31 / $493.58
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$999.54 / $3,080.66 / $3,114.29
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,353.09 / $3,433.55 / $4,291.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.33 / $285.49 / $430.15