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Tennessee rates for HCPCS L5650

Additions to lower extremity, total contact, above knee (AK) or knee disarticulation socket

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.97 / $253.85 / $253.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.97 / $278.26 / $436.11
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$439.46 / $439.46 / $439.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.11 / $527.35 / $527.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$313.20 / $379.03 / $379.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.69 / $276.69 / $379.03
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,109.38 / $3,128.86 / $3,710.94
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,890.63 / $3,890.63 / $5,859.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.88 / $292.32 / $450.45