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Tennessee rates for HCPCS L5638

Addition to lower extremity, below knee (BK), leather socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$256.64 / $261.67 / $261.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.64 / $265.25 / $449.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$359.87 / $543.60 / $543.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$312.23 / $503.81 / $503.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.78 / $367.78 / $483.20
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,054.13 / $3,083.04 / $3,699.35
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,878.47 / $3,878.47 / $5,270.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$388.77 / $388.77 / $388.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.89 / $301.33 / $439.06