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Tennessee rates for HCPCS L5628

Addition To Lower Extremity Test Socket Hemipelvectomy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.00 / $265.10 / $265.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.00 / $265.10 / $455.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.57 / $550.70 / $550.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.77 / $499.82 / $499.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.87 / $364.87 / $499.82
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$826.05 / $3,076.44 / $3,076.44
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,592.02 / $3,592.02 / $4,487.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$222.75 / $382.03 / $435.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.51 / $305.27 / $442.41