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Tennessee rates for HCPCS L5658

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.43 / $189.07 / $189.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.43 / $191.07 / $355.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.01 / $392.76 / $392.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$233.27 / $366.26 / $366.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.37 / $267.37 / $366.26
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$589.14 / $2,323.85 / $2,323.85
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,880.26 / $2,880.26 / $3,523.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.13 / $217.72 / $328.04