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Tennessee rates for HCPCS L6629

Upper extremity addition, quick disconnect lamination collar with coupling piece, Otto Bock or equal

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.61 / $76.08 / $76.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.61 / $83.39 / $130.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.63 / $158.04 / $158.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.86 / $113.00 / $113.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.49 / $82.49 / $113.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$315.48 / $917.84 / $998.26
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,095.59 / $1,095.59 / $1,577.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.40 / $87.61 / $131.99