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Tennessee rates for HCPCS L5972

All Lower Extremity Prostheses Foot Flexible Keel (Revised 01012013)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.47 / $197.26 / $197.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.68 / $197.26 / $338.90
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$341.50 / $341.50 / $387.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.27 / $409.80 / $409.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.11 / $293.77 / $293.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.45 / $214.45 / $293.77
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$727.68 / $2,270.36 / $2,679.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,957.04 / $3,028.01 / $3,172.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.44 / $227.15 / $317.95