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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
$905.88 / $923.64 / $923.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$905.88 / $923.64 / $1,597.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,270.23 / $1,918.76 / $1,918.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,115.90 / $1,620.00 / $1,620.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,182.59 / $1,182.59 / $1,620.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,605.97 / $11,250.63 / $13,221.44
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13,778.13 / $13,778.13 / $15,657.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$709.07 / $1,063.60 / $1,569.19