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Tennessee rates for HCPCS L5696

Addition to lower extremity, above knee (AK) or knee disarticulation, pelvic joint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.36 / $96.21 / $96.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.36 / $104.97 / $165.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.31 / $199.86 / $199.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.70 / $138.76 / $138.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.29 / $101.29 / $138.76
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.65 / $1,184.51 / $1,406.43
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,469.79 / $1,505.07 / $1,809.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.86 / $110.79 / $166.92