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Tennessee rates for HCPCS L5679

Addition To Lower Extremity Below Knee/Above Kneecustom Fabricated Fromexisting Mold Or Prefabric Ated Socket Insert Silicone Gel Elastomeric Or Equal Not For Use With Locking Mechanism

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.18 / $308.10 / $308.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.18 / $308.10 / $529.30
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$533.38 / $533.38 / $604.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.72 / $640.04 / $640.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$357.25 / $440.05 / $440.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.24 / $321.24 / $440.05
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,118.90 / $3,490.95 / $3,722.67
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,773.79 / $3,773.79 / $5,012.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.53 / $354.79 / $502.37