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Tennessee rates for HCPCS L5782

Addition to lower limb prosthesis, vacuum pump, residual limb volume management and moisture evacuation system, heavy-duty

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $3,890.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,187.76 / $2,454.71 / $4,265.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,801.89 / $3,801.89 / $4,073.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,311.31 / $3,311.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $3,311.31
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23,442.29 / $23,442.29 / $23,442.29
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25,703.96 / $37,153.52 / $37,153.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $3,019.95 / $3,630.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,511.89 / $3,388.44