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Tennessee rates for HCPCS L5505

Initial, above knee (AK), knee disarticulation, ischial level socket, nonalignable system, pylon, no cover, SACH foot, plaster socket, direct formed

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $912.01 / $1,621.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,122.02 / $1,778.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $1,698.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,621.81 / $1,621.81 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,621.81
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,182.57 / $13,182.57 / $13,182.57
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,803.84 / $15,488.17 / $15,488.17
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,380.38 / $1,621.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,047.13 / $1,584.89