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Tennessee rates for HCPCS L5655

Addition to lower extremity, socket insert, below knee (BK) (Kemblo, Pelite, Aliplast, Plastazote or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.33 / $146.13 / $146.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.33 / $160.54 / $251.06
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$286.73 / $286.73 / $286.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.98 / $303.60 / $303.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.18 / $221.07 / $221.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.38 / $161.38 / $221.07
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$608.32 / $1,741.43 / $2,016.23
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,062.46 / $2,062.46 / $3,071.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.19 / $168.29 / $239.30