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Tennessee rates for HCPCS L5685

Addition to lower extremity prosthesis, below knee, suspension/sealing sleeve, with or without valve, any material, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.06 / $67.34 / $67.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.94 / $67.34 / $115.71
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.60 / $116.60 / $132.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.63 / $139.91 / $139.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.00 / $100.03 / $100.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.02 / $73.02 / $100.03
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.87 / $720.06 / $720.06
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$778.52 / $778.52 / $1,131.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.70 / $77.56 / $103.83