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Tennessee rates for HCPCS L5975

All lower extremity prostheses, combination single axis ankle and flexible keel foot

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.10 / $243.79 / $243.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.70 / $243.79 / $418.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$335.27 / $506.46 / $506.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.98 / $362.03 / $362.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.27 / $264.27 / $362.03
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$759.69 / $2,615.79 / $2,615.79
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,817.63 / $2,817.63 / $4,096.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.16 / $280.73 / $375.80