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Tennessee rates for HCPCS L5629

Addition to lower extremity, below knee, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.07 / $165.25 / $165.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.07 / $181.14 / $283.89
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.07 / $286.07 / $381.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.26 / $343.29 / $343.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$203.90 / $248.05 / $248.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.08 / $181.08 / $248.05
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.92 / $2,003.74 / $2,003.74
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,517.42 / $2,517.42 / $3,814.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.86 / $190.30 / $286.70