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Tennessee rates for HCPCS L5614

Addition to lower extremity, exoskeletal system, above knee (AK), knee disarticulation, four-bar linkage, with pneumatic swing phase control

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.27 / $887.34 / $887.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$868.74 / $887.34 / $1,524.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,220.32 / $1,843.35 / $1,843.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,062.81 / $1,317.79 / $1,317.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.99 / $961.99 / $1,317.79
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,765.03 / $9,502.08 / $9,502.08
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,479.07 / $14,912.18 / $15,058.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$681.20 / $1,021.81 / $1,367.91