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Tennessee rates for HCPCS L5668

Addition to lower extremity, below knee (BK), molded distal cushion

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $57.54 / $102.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $66.07 / $114.82
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $120.23 / $123.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $109.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $89.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $64.57 / $89.13
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $776.25
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $954.99 / $954.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $79.43 / $93.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $66.07 / $91.20