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Tennessee rates for HCPCS L5976

All lower extremity prostheses, energy storing foot (Seattle Carbon Copy II or equal)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $288.40 / $512.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $354.81 / $588.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $501.19 / $537.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $416.87 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $416.87
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $4,265.80 / $4,265.80
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,011.87 / $6,309.57 / $6,309.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $446.68 / $512.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $338.84 / $501.19