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Tennessee rates for HCPCS L5631

Addition to lower extremity, above knee (AK) or knee disarticulation, acrylic socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$224.08 / $228.47 / $228.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.08 / $250.44 / $392.50
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.52 / $395.52 / $395.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.20 / $474.62 / $474.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.89 / $329.53 / $329.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$240.56 / $240.56 / $329.53
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$711.94 / $2,777.21 / $2,777.21
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,480.59 / $3,480.59 / $5,273.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.40 / $263.08 / $405.42