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Tennessee rates for HCPCS L5220

Above knee (AK), short prosthesis, no knee joint (stubbies), with articulated ankle/foot, dynamically aligned, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,406.67 / $1,434.25 / $1,434.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,406.67 / $1,542.49 / $2,473.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,972.47 / $2,979.51 / $2,979.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,769.62 / $2,482.86 / $2,482.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,812.49 / $1,812.49 / $2,482.86
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,665.02 / $17,674.86 / $20,966.93
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22,536.86 / $23,077.76 / $26,583.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,272.54 / $2,182.50 / $2,545.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,101.07 / $1,651.61 / $2,488.46