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Tennessee rates for HCPCS L5677

Additions to lower extremity, below knee (BK), knee joints, polycentric, pair

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.45 / $256.38 / $256.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.45 / $257.52 / $440.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$352.59 / $532.60 / $532.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.33 / $400.78 / $400.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.57 / $292.57 / $400.78
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,002.68 / $3,128.35 / $3,747.94
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,372.97 / $4,477.91 / $4,477.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$196.82 / $295.24 / $444.83