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Tennessee rates for HCPCS L5656

Addition To Lower Extremity Socket Insert Knee Disarticulation (Kemblo Pelite Aliplast Plastazote Or Equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.28 / $196.05 / $196.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.28 / $199.75 / $340.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.61 / $407.27 / $407.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.30 / $335.84 / $335.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.16 / $245.16 / $335.84
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$872.19 / $2,344.02 / $2,819.79
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,938.52 / $2,938.52 / $4,364.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.50 / $225.76 / $334.67