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Tennessee rates for HCPCS L5654

Addition to lower extremity, socket insert, Symes, (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.14 / $172.45 / $172.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.14 / $183.45 / $296.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.17 / $358.25 / $358.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$212.77 / $306.16 / $306.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.50 / $223.50 / $306.16
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$669.57 / $2,089.06 / $2,322.98
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,347.44 / $2,347.44 / $3,161.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.38 / $198.59 / $299.20