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Tennessee rates for HCPCS L5698

Addition to lower extremity, above knee (AK) or knee disarticulation, Silesian bandage

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.95 / $68.26 / $68.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.01 / $68.26 / $117.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.88 / $141.80 / $141.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.92 / $99.25 / $99.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.45 / $72.45 / $99.25
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$241.99 / $682.16 / $782.09
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.32 / $790.32 / $1,179.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.13 / $82.54 / $93.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.05 / $76.97 / $96.25